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What's new in the treatment of serious MRSA infection?

Holmes, Natasha E.a; Howden, Benjamin P.a,b,c

Current Opinion in Infectious Diseases: December 2014 - Volume 27 - Issue 6 - p 471–478
doi: 10.1097/QCO.0000000000000101
ANTIMICROBIALS: Edited by Monica A. Slavin and William Irving

Purpose of review Vancomycin has been the cornerstone of treatment for methicillin-resistant Staphylococcus aureus (MRSA) infections. This review describes new MRSA-active antibiotics that have recently been introduced and highlights emerging resistance.

Recent findings Elevations in the vancomycin minimum inhibitory concentration within the susceptible range are associated with treatment failure and mortality in the treatment of MRSA infections. Ceftaroline and ceftobiprole are anti-MRSA cephalosporins and are noninferior to comparator agents in the treatment of acute bacterial skin and skin structure infections (ABSSSIs) and pneumonia. Tedizolid is more potent than linezolid, has improved pharmacokinetics and reduced toxicity and is active against cfr-containing S. aureus. Telavancin now has approval for treatment of hospital-acquired pneumonia, and recent phase 2 trial data showed similar cure rates in S. aureus bacteremia. Dalbavancin and oritavancin are administered once weekly and are noninferior to comparators for acute bacterial skin and skin structure infections. Resistance has emerged against many new anti-MRSA antimicrobials including ceftaroline. Combination therapy of β-lactams with vancomycin or daptomycin is increasing.

Summary Several new MRSA-active agents are now approved for use, although much of the data is derived from treatment of acute bacterial skin and skin structure infections or pneumonia. Further studies are required for more invasive infections, such as bacteremia and endocarditis.

aDepartment of Infectious Diseases, Austin Centre for Infection Research, Austin Health, Heidelberg

bDepartment of Microbiology and Immunology, Microbiological Diagnostic Unit, University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Parkville

cDepartment of Microbiology, Monash University, Clayton, Victoria, Australia

Correspondence to Professor Benjamin P. Howden, Microbiological Diagnostic Unit, University of Melbourne, Peter Doherty Institute for Infection and Immunity, First Floor, Building 248, The University of Melbourne, Parkville VIC 3010, Australia. Tel: +61 3 8344 5701; fax: +61 3 8344 7833; e-mail:

© 2014 Lippincott Williams & Wilkins, Inc.