Drug Topics - January 2009 - (Page 39) CONTINUING EDUCATION Telavancin Telavancin possesses a dual mechanism of action. It causes rapid, concentration-dependent depolarization of the plasma membrane and increases cell permeability, and leakage of cellular ATP and potassium. Telavancin also prevents the effective formation of the bacterial cell wall. In a clinical trial involving uncomplicated and complicated skin and skin-structure infections, telavancin was compared against an antistaphylococcal penicillin or vancomycin. In the MRSA subgroup, there was a 96 percent cure rate vs. 90 percent in the telavancin and comparators groups, respectively. Telavancin, which appears to be a promising option for the treatment of severe infections caused by MRSA, is in the review process at the FDA. A decision should be made in early 2009. Prevention Personal hygiene One of the best defenses against the spread of CA-MRSA is proper personal hygiene. Handwashing and overall cleanliness are essential in preventing transmission of MRSA. In both hospital and community settings, handwashing has been shown to decrease the incidence of MRSA infections. One report stated that handwashing is responsible for 80 percent of transmission control. A study showed lower CA-MRSA incidence among inmates who washed their hands and showered more than other inmates. Frequent and proper handwashing is a simple but exceedingly effective means of preventing the spread of MRSA in the hospital and in the community. Dalbavancin Dalbavancin possesses bactericidal activity in vitro against a variety of gram-positive bacteria, including MRSA. It has been compared to linezolid for the treatment of complicated skin and soft-tissue infections. In the subgroup analysis of MRSA infections, dalbavancin and linezolid demonstrated a 91 percent and 89 percent eradication rate, respectively. The long half-life of dalbavancin allows for once-weekly dosing. This dosing strategy may be attractive for outpatient treatment; however, concerns over consequences regarding the duration of allergic or adverse reactions need to be addressed. Dalbavancin is undergoing further phase 3 clinical trials at this time and a release date has not been scheduled. Decolonization MRSA decolonization has been attempted both to abort outbreaks and to prevent disease recurrence. Various decolonization strategies have been studied, but convincing evidence regarding effectiveness among outpatients with CA-MRSA is lacking. One strategy for decolonization is use of mupirocin nasal ointment. Intranasal mupirocin has been used to decrease CA-MRSA colonization rates in soldiers. Even though rates of colonization were reduced, this did not prevent infection or recolonization. Although mupirocin has shown some promise in the past, data are inconsistent and increasing resistance rates have developed. Currently, mupirocin is not recommended for routine use to decolonize patients. Chlorhexidine body washes are another means of decolonization. Most relevant studies have evaluated hospitalized patients and limited data are available on CA-MRSA. Therefore, a recommendation regarding chlorhexidine body washes cannot be made. It has been suggested that a combination of chlorhexidine, nasal mupirocin, and oral antibiotics used in conjunction may be effective for decontamination. Ceftobiprole Ceftobiprole is a broad-spectrum cephalosporin antibiotic with activity against a variety of gram-negative and gram-positive bacteria, including MRSA, VISA, and VRSA. It was specifically developed for increased activity against MRSA by creating a strong affinity for the penicillin-binding proteins PBP2a and PBP2x. This is important, since resistance to the beta-lactams is mediated by PBP2a. In a trial comparing ceftobiprole to vancomycin in the treatment of skin and soft-tissue infections, the clinical cure rates were similar in the MRSA subgroup: 91.8 percent vs. 90 percent, respectively. Nausea was the most common adverse effect, occurring in 14 percent of patients. At the time of this review, the FDA had issued a response letter to the sponsor of ceftobiprole and further data were requested. Vaccine There has been interest in vaccines against many infections, and MRSA is no exception. One possibility is a DNA vaccine that has shown a positive response in mice. Development of a vaccine could be a significant step in controlling the spread of MRSA, as well as in reducing morbidity and mortality. Intravenous immunoglobulin (IVIG) Studies have recently demonstrated that intravenous immunoglobulin contains biologically active antibodies to PVL in vitro. It has been suggested that the use of IVIG therapy in the presence of life-threatening CA-MRSA infections may be beneficial. Unfortunately, the available clinical data on IVIG mainly consist of case reports. More studies are warranted. Other antimicrobials and combinations have been mentioned in the literature, but limited data are available at this time. These agents include but are not limited to iclaprim, faropenem, and carbapenems. W W W.D R U GTO P I C S .C O M Conclusion CA-MRSA is a serious public health problem. Practitioners must recognize the signs and symptoms of CA-MRSA, and understand the treatment options. Outpatient treatment of skin and soft-tissue infections is reasonable for patients with mild to moderate infections; however, severe skin infections and systemic infection may require use of inpatient intravenous antibiotics. The spread of CA-MRSA may best be controlled through handwashing and personal hygiene. To prevent the spread of resistance as well as morbidity and mortality, preventing CA-MRSA infections is vital. References are available upon request. For a general overview and ongoing updates on CA-MRSA, visit www.cdc.gov. Januar y 2009 DRUG TOPICS 39 http://www.cdc.gov http://WWW.DRUGTOPICS.COM
Table of Contents Feed for the Digital Edition of Drug Topics - January 2009 Drug Topics - January 2009 Contents Letters Up Front Up Front in Depth Community Practice Drug Pipeline: What to Watch in 2009 OTC Community-Aquired MRSA Infections New Products Viewpoint Drug Topics - January 2009 Drug Topics - January 2009 - Drug Topics - January 2009 (Page Cover1) Drug Topics - January 2009 - Drug Topics - January 2009 (Page Cover2) Drug Topics - January 2009 - Drug Topics - January 2009 (Page 1) Drug Topics - January 2009 - Drug Topics - January 2009 (Page 2) Drug Topics - January 2009 - Drug Topics - January 2009 (Page 3) Drug Topics - January 2009 - Contents (Page 4) Drug Topics - January 2009 - Contents (Page 5) Drug Topics - January 2009 - Contents (Page 6) Drug Topics - January 2009 - Contents (Page 7) Drug Topics - January 2009 - Contents (Page 8) Drug Topics - January 2009 - Contents (Page 9) Drug Topics - January 2009 - Contents (Page 10) Drug Topics - January 2009 - Contents (Page H1) Drug Topics - January 2009 - Contents (Page H2) Drug Topics - January 2009 - Contents (Page H1) Drug Topics - January 2009 - Contents (Page H2) Drug Topics - January 2009 - Contents (Page H3) Drug Topics - January 2009 - Contents (Page H4) Drug Topics - January 2009 - Contents (Page H5) Drug Topics - January 2009 - Contents (Page H6) Drug Topics - January 2009 - Contents (Page H7) Drug Topics - January 2009 - Contents (Page H8) Drug Topics - January 2009 - Contents (Page 13) Drug Topics - January 2009 - Up Front (Page 14) Drug Topics - January 2009 - Up Front (Page 15) Drug Topics - January 2009 - Up Front (Page 16) Drug Topics - January 2009 - Up Front (Page 17) Drug Topics - January 2009 - Up Front in Depth (Page 18) Drug Topics - January 2009 - Up Front in Depth (Page 19) Drug Topics - January 2009 - Community Practice (Page 20) Drug Topics - January 2009 - Community Practice (Page 20a) Drug Topics - January 2009 - Community Practice (Page 20b) Drug Topics - January 2009 - Community Practice (Page 21) Drug Topics - January 2009 - Drug Pipeline: What to Watch in 2009 (Page 22) Drug Topics - January 2009 - Drug Pipeline: What to Watch in 2009 (Page 23) Drug Topics - January 2009 - Drug Pipeline: What to Watch in 2009 (Page 24) Drug Topics - January 2009 - Drug Pipeline: What to Watch in 2009 (Page 25) Drug Topics - January 2009 - Drug Pipeline: What to Watch in 2009 (Page 26) Drug Topics - January 2009 - Drug Pipeline: What to Watch in 2009 (Page 27) Drug Topics - January 2009 - OTC (Page 28) Drug Topics - January 2009 - OTC (Page 29) Drug Topics - January 2009 - OTC (Page 30) Drug Topics - January 2009 - OTC (Page 31) Drug Topics - January 2009 - Community-Aquired MRSA Infections (Page 32) Drug Topics - January 2009 - Community-Aquired MRSA Infections (Page 33) Drug Topics - January 2009 - Community-Aquired MRSA Infections (Page 34) Drug Topics - January 2009 - Community-Aquired MRSA Infections (Page 35) Drug Topics - January 2009 - Community-Aquired MRSA Infections (Page 36) Drug Topics - January 2009 - Community-Aquired MRSA Infections (Page 37) Drug Topics - January 2009 - Community-Aquired MRSA Infections (Page 38) Drug Topics - January 2009 - Community-Aquired MRSA Infections (Page 39) Drug Topics - January 2009 - Community-Aquired MRSA Infections (Page 40) Drug Topics - January 2009 - Community-Aquired MRSA Infections (Page 41) Drug Topics - January 2009 - New Products (Page 42) Drug Topics - January 2009 - New Products (Page 43) Drug Topics - January 2009 - New Products (Page 44) Drug Topics - January 2009 - New Products (Page 45) Drug Topics - January 2009 - New Products (Page 46) Drug Topics - January 2009 - New Products (Page 47) Drug Topics - January 2009 - Viewpoint (Page 48) Drug Topics - January 2009 - Viewpoint (Page Cover3) Drug Topics - January 2009 - Viewpoint (Page Cover4)
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