Saturday, June 30, 2007

Tetracyclines and Methicillin-Resistant Staphylococcus Aureus MRSA

Tetracyclines as an Oral Treatment Option for Patients with Community-Onset Methicillin-Resistant Staphylococcus aureus Skin and Soft-Tissue Infections.

Antimicrob Agents Chemother. 2007 Jun 18

Ruhe JJ, Menon A.

Division of Infectious Diseases, Department of Medicine, University of Arkansas for Medical Sciences; and Central Arkansas Veterans Healthcare System, Little Rock, Arkansas, U.S.A.

Few data exist on the clinical utility of the second-generation tetracyclines doxycycline and minocycline for the treatment of community-associated methicillin-resistant Staphylococcus aureus (MRSA) skin and soft-tissue infections (SSTI). We performed a retrospective cohort study on 282 patients who presented with MRSA SSTI to the emergency room or outpatient clinic at two tertiary medical centers between October 2002 and February 2007. Median MRSA susceptibility to tetracycline was 95%. Time zero was defined as the time of the first incision and drainage procedure or, if none was performed, the time of the first positive wound culture. The median patient age was 48 years.

Abscesses constituted the majority of clinical presentations (75%), followed by furuncles or carbuncles (13%), and cellulitis originating from a purulent focus of infection (12%). 225 (80%) patients underwent incision and drainage. Doxycycline or minocycline was administered in 90 (32%) episodes; the other 192 SSTI were treated with beta-lactams. Treatment failure, defined as the need for a second incision and drainage procedure and/or admission to the hospital by at least two days after time zero, was diagnosed in 28 (10%) episodes at a median of three days after time zero. On logistic regression analysis, receipt of a beta-lactam agent was the only clinical characteristic associated with treatment failure (adjusted OR 3.94; 95% CI, 1.28-12.15; P=0.02).

The second-generation tetracyclines appear to be a reasonable oral treatment option for patients with community-onset MRSA SSTI in areas where MRSA are susceptible to the tetracyclines.

Antimicrobial Agents and Chemotherapy