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Advantages and Disadvantages of Newer Approved Drugs with Activity Against MRSA
effect. It is not a substrate for cytochrome P450 enzyme system. Dose benefits to patients. On the other hand, irrational and indiscriminate
adjustment is not necessary in patients with renal failure.
32
Tigecycline use must be avoided at all costs, as this would invariably lead to
is available only for intravenous use. the emergence of resistant strains. The selection of these agents must
take into account the underlying infection, the desired length of
Agents in Clinical Development treatment, whether part of the treatment can be completed outside
Several agents active against MRSA are in advanced stages of the hospital environment and the potential toxicity of individual
clinical development. Dalbavancin is structurally related to teicoplanin
and may be very useful for the treatment of MRSA infections.
Dalbavancin is also active against vancomycin-intermediate-resistant
strains.
33
Its once-a-week dosing schedule allows outpatient
Good infection control practices,
treatment wherever possible. In a recent trial, two doses of dalbavancin
limiting the indiscriminate use of
one week apart (1gm on day one and 500mg on day eight) were
antibiotics and effective clinical
comparable to twice-daily linezolid for 14 days for the treatment of
CSSIs. Other glycopeptides that may be licensed in future include teamwork have a major role to play if
telavancin and oritavancin. Telavancin was found to be significantly
we are to win the battle against MRSA.
more effective than standard therapy for MRSA skin and soft tissue
infections.
34
Ceftobiprole is a novel cephalosporin that binds to PBP 2’ of
MRSA. It is bactericidal and has been found to be effective against
MRSA strains not susceptible to daptomycin when tested in vitro.
35
agents. Finally, it should be appreciated that antibiotics alone are
not the answer. Good infection control practices, limiting the
Conclusions indiscriminate use of antibiotics that select resistant bacterial strains
The newer available agents add to our existing armamentarium and effective clinical teamwork have a major role to play if we are to
against MRSA. Judicious use of these agents can bring significant win the battle against MRSA. ■
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