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INFECTIOUS DISEASES

Community-Associated Methicillin-Resistant Staphylococcus aureus: New Bug, Old Drugs

Clinical Pharmacy Specialist, Infectious Diseases, Parkland Health and Hospital System, Dallas, TX

Kelly L Echevarria, PharmD BCPS

Clinical Pharmacy Specialist, Infectious Diseases, Pharmacy Service, South Texas Veterans Healthcare System, San Antonio, TX; Clinical Assistant Professor, Departments of Clinical Pharmacy and Pharmacology, The University of Texas Health Science Center, San Antonio

James S Lewis II, PharmD

Clinical Pharmacy Specialist, Infectious Diseases, Pharmacy Service, University Health System, San Antonio; Clinical Assistant Professor, Departments of Clinical Pharmacy and Pharmacology, The University of Texas Health Science Center

Reprints: Dr. Lewis, Pharmacy Service, University Health System, 4502 Medical Dr., San Antonio, TX 78229-4493, James.Lewis{at}uhs-sa.com

OBJECTIVE: To discuss community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections and evaluate older antibiotics as suitable therapeutic treatment options.

DATA SOURCES: Searches of MEDLINE, EMBASE, and the Cochrane Library (1966-May 2006) were performed using the key terms methicillin resistance, community-acquired, community associated, treatment, Staphylococcus aureus, mec, and Panton-Valentine leukocidin.

STUDY SELECTION AND DATA EXTRACTION: All articles were critically evaluated and all relevant information was included in this review.

DATA SYNTHESIS: There has been a documented shift of methicillin resistance occurring in staphylococcal infections manifested within the community. Infections caused by CA-MRSA possess unique characteristics including lack of hospital-associated risk factors, improved susceptibility patterns, distinct genotypes, faster doubling times, and additional toxins. Potential therapeutic options to treat these infections include trimethoprim/sulfamethoxazole (TMP/SMX), clindamycin, tetracyclines, fluoroquinolones, and new antimicrobials.

CONCLUSIONS: CA-MRSA infections can be successfully treated with older, oral antibiotic agents including TMP/SMX, clindamycin, and tetracyclines. Fluoroquinolones and linezolid should be avoided as first-line agents.

Key Words: methicillin resistance, community-acquired, community associated; Panton-Valentine leukocidin, Staphylococcus aureus, mec.

Published Online, May 30, 2006. www.theannals.com, DOI 10.1345/aph.1G404

THIS ARTICLE IS APPROVED FOR CONTINUING EDUCATION CREDIT
ACPE UNIVERSAL PROGRAM NUMBER: 407-000-06-013-H01

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