Drug Topics - November 12, 2007 - (Page 7)

7 Home hygiene helps tame MRSA Fred Gebhart f your patients have not met USA300, they probably will. This superstrain of methicillin-resistant Staphylococcus aureus (MRSA) has emerged as a global health concern among groups that gather in close proximity: professional and amateur sports teams, clubs, schools, prisons, and families. “I think we’ve all seen couples and families where MRSA ping-pongs back and forth and seems impossible to eradicate,” said Mark Peluso, M.D., head team physician for Middlebury College, Middlebury, Vt. “The prevention principles are the same in any group, whether you’re talking sports teams or families.” Middlebury’s athletic department had a MRSA outbreak several years ago that was traced to an unlicensed tattoo artist, he told the recent American Academy of Family Physicians Annual Scientific Sessions meeting in Chicago. “Prevention works,” Peluso said. “We have had only two MRSA cases in the past three years after we instituted prevention measures.” Prevention is not complicated, he added. MRSA is typically spread by contact and surface contamination. I 2005 when the New England Journal of Medicine published a report on an outbreak among St. Louis Rams football players. There is no empiric treatment for USA300, Peluso continued. Infections must be cultured and tested. “You have to know what will kill your specific bug,” he said. “Empiric therapy won’t work and will add to existing resistance problems.” Fluoroquinolones are not recommended due to widespread resistance, he continued. Trimethoprimsulfamethoxazole, doxycycline, clindamycin, and linezolid (Zyvox, Pfizer) are likely candidates, depending on local susceptibility patterns. So is rifampin in combination with other agents. More resistant infections may require intravenous treatment with vancomycin, clindamycin, daptomycin (Cubicin, Cubist), tigecycline (Tygacil, Wyeth), or linezolid. Drug resistance How long those agents will continue to be effective is an open question. Drug resistance has been growing at least since the 1950s, warned Thomas Kintanar, M.D., a private-practice physician in Fort Wayne, Ind. “We have had antibiotic overuse guidelines for more than 20 years,” he said, “and we are still seeing a great increase in infectious disease deaths due to resistant organisms. In 1998, CDC reported that one-third of antibiotic use was inappropriate. The issue may well have escalated.” “The prevention principles Resistant strains of Staph aureus, Enterococcus, and are the same in any group, other organisms are also be- whether you’re talking hind the growing incidence of necrotizing fasciitis, scar- sports teams or families.” ring, and other permanent Mark Peluso, M.D. injuries associated with in- Head team physician, fection. Middlebury College, Middlebury, Vt. Inappropriate antibiotic use is part of the problem. Most upper respiratory infections are viral in nature, Kintanar noted, and should never be treated with antibiotics. But most patients demand antibiotics. And so do parents of children with An ounce of prevention Simple household measures such as frequent handwashing or use of alcohol-based hand cleansers, frequent cleaning of shared surfaces, and use of separate towels or other personal items are key. Prompt treatment of scrapes, cuts, and other wounds is also essential. For years, healthcare providers have been wary of community-acquired MRSA, Peluso said. The first report of what would be identified as USA300 came from the United Kingdom in 1998. Five members of a rugby team contracted non-healing abscesses. Genetic analysis showed MRSA, but it was a new strain that was both highly virulent and highly resistant to treatment. The same strain was identified in U.S. college football players in 2000 and 2002. In 2003, the same bug infected high school wrestlers from different teams who had not wrestled each other. Then USA300 hit a private fencing club. In August 2003, the Centers for Disease Control & Prevention warned of the new strain in Morbidity and Mortality Weekly Report. USA300 made headlines in

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Drug Topics - November 12, 2007 Contents Drugs Often Associated with Errors Wanted: More Convers to Drug Decision Tools MSRA Takeoff Raising Alarm Bells U.S. Still Volnerable to Drug Counterfeiting Strange Rx Stories: Are You Stupid? Are Students a Squandered Opportunity The Week at a Glance

Drug Topics - November 12, 2007

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