title: Safety profiles of old and new antimicrobials for the treatment of MRSA infections.
abstract: BACKGROUND
  Methicillin-resistant Staphylococcus aureus (MRSA) is a frequent cause of severe nosocomial and community-acquired infections. Various adverse effects have been associated with compounds that are commonly used in the treatment of MRSA.
  
  
  METHODS
  Prolonged use of high-dose vancomycin has been linked with nephrotoxicity. Linezolid use has been associated with lactic acidosis in regimens longer than 14 days and occurrence of thrombocytopenia in patients with renal impairment. Daptomycin use correlates with reversible and often asymptomatic myopathy. Among new compounds, telavancin has shown increased toxicity compared to vancomycin, especially in patients with severe renal impairment, while a low rate of adverse effects was reported others glycolipopeptides such as dalbavancin and oritavancin and for new cephalosporins. Recently studied oxazolidinones (tedizolid and radezolid) also showed mild adverse effects in Phase 2 and 3 clinical trials.
  
  
  CONCLUSIONS
  Due to the constant increase in antimicrobial resistance, the use of higher doses and prolonged regimens of antibiotics employed in the treatment of Gram-positive infections has become more common and linked to increased toxicity. Furthermore, new compounds with MRSA activity have been recently approved and will be regularly employed in clinical practice. The knowledge of the adverse effects and risk factors for the development of toxicity associated with anti-MRSA antimicrobials is paramount for the correct use of old and new compounds, especially in the treatment of severe infections.
authors.affiliation: a Infectious Diseases Division , Santa Maria Misericordia Hospital , Udine , Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Bassetti
authors.affiliation: a Infectious Diseases Division , Santa Maria Misericordia Hospital , Udine , Italy.
authors.forename: Elda
authors.initials: E
authors.lastname: Righi
mesh_terms: D000818:Animals; D000890:Anti-Infective Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D003428:Cross Infection / Q000188:drug therapy; D024881:Drug Resistance, Bacterial / Q000187:drug effects; D064420:Drug-Related Side Effects and Adverse Reactions / Q000517:prevention & control; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects*; D012449:Safety; D013203:Staphylococcal Infections / Q000188:drug therapy*
chemical_list: D000890:Anti-Infective Agents
keywords: MRSA; daptomycin; drug toxicity; glycopeptides; new cephalosporins; oxazolidinones