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Senior Pharmacy Practice Management Resident The University of Kansas Hospital 3901 Rainbow Boulevard Kansas City, Kansas 66160-7231 fax 913/588-8840 mcarter{at}kumc.edu
Drug Information Specialist Department of Pharmacy Practice School of Pharmacy The University of Kansas Hospital Kansas City
Assistant Professor Department of Internal Medicine Division of Infectious Diseases School of Medicine The University of Kansas Hospital
Associate Professor Department of Pharmacy Practice School of Pharmacy The University of Kansas Hospital
Published Online, August 8, 2006. www.theannals.com, DOI 10.1345/aph.1H084
Methods. To assess the efficacy of oral doxycycline, medical records of outpatients treated for MRSA SSTI in 2005 were retrospectively reviewed. An infectious disease physician (BY) verified and reviewed all collected data. Inclusion criteria for assessment consisted of SSTI with MRSA, documented positive MRSA culture, no discernible association of MRSA acquisition with a healthcare source, treatment with oral doxycycline, and documented follow-up assessment of clinical efficacy.
Results. Details of the individual patient cases are outlined in Table 1. The 5 identified adults had infected skin lesions at multiple sites. All 5 patients were successfully treated with doxycycline 100 mg orally twice daily after failing treatment or experiencing infection recurrence with other antimicrobial agents. Susceptibility information regarding tetracycline was available for 3 patients prior to doxycycline therapy. Treatment was continued until resolution of infection, with durations ranging from 1 to 3 months. No doxycycline adverse effects were noted in the medical records and no patient discontinued therapy before resolution of infection.
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Discussion. Definitive treatment guidelines for SSTI3 had not been published until recently. Even though doxycycline is listed as a treatment option for MRSA SSTI and is frequently used in clinical practice,2 limited published data were located in a PubMed search (up to February 2006). Furthermore, there was no information concerning the use of doxycycline in combination with other antibiotics for the treatment of CA-MRSA infections. Most data concerning doxycycline for CA-MRSA recommend using doses of 100 mg twice daily.2,4 The selection of available oral treatment options should be based on current treatment guidelines and patient allergies, prior antibiotic use, and level of renal and hepatic function. According to a recent publication, the cost for a 10 day oral antibiotic regimen to treat CA-MRSA ranges from less than $10 to over $1200.4 With this considerable cost variance, published cases of efficacy with less expensive antibiotic regimens may be helpful for clinicians when they select therapy.
One case series described treatment of 24 patients with either doxycycline or minocycline for a variety of MRSA infections.2,3 Twenty of the patients were successfully treated. The majority (67%) had SSTI, and most (69%) were treated with doxycycline. Only one treatment failure with doxycycline was reported in patients with SSTI. However, this failure was associated with medication intolerance.
In conclusion, based on the current MRSA treatment guidelines for SSTI, the case series data presented in Table 1, and available clinical information, doxycycline appears to be a useful option in the treatment of MRSA SSTI.
References
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