Adjunctive Use of Rifampin for the Treatment of Staphylococcus aureus Infections

Abstract

Background: Staphylococcus aureus causes severe lifethreatening infections and has become increasingly common, particularly methicillin-resistant strains. Rifampin is often used as adjunctive therapy to treat S aureus infections, but there have been no systematic investigations examining the usefulness of such an approach. Methods: A systematic review of the literature to identify in vitro, animal, and human investigations that compared single antibiotics alone and in combination with rifampin therapy against S aureus.Results: The methods of in vitro studies varied substantially among investigations. The effect of rifampin therapy was often inconsistent, it did not necessarily correlate with in vivo investigations, and findings seemed heavily dependent on the method used. In addition, the quality of data reporting in these investigations was often suboptimal. Animal studies tended to show a microbiologic ben-efit of adjunctive rifampin use, particularly in osteomyelitis and infected foreign body infection models; however, many studies failed to show a benefit of adjunctive therapy. Few human studies have addressed the role of adjunctive rifampin therapy. Adjunctive therapy seems most promising for the treatment of osteomyelitis and prosthetic device-related infections, although studies were typically underpowered and benefits were not always seen. Conclusions:In vitro results of interactions between rifampin and other antibiotics are method dependent and often do not correlate with in vivo findings. Adjunctive rifampin use seems promising in the treatment of clinical hardware infections or osteomyelitis, but more definitive data are lacking. Given the increasing incidence of S aureus infections, further adequately powered investigations are needed.

Non-compliance with IDSA guidelines for patients presenting with methicillin-susceptible Staphylococcus aureus prosthetic joint infection is a risk factor for treatment failure

“…For this reason, it is considered the drug of choice for the treatment of S. aureus PJI in combination with an appropriate anti-staphylococcal agent to prevent acquisition of resistance [1,2]. However, little data has clearly demonstrated the superiority of rifampicin-based regimens in comparison with other combinations in patients presenting with S. aureus PJI, and there is a debate on the adequate dose for patients presenting with PJI [9,[14][15][16][17].…”

Randomized non-inferiority trial to compare trimethoprim/sulfamethoxazole plus rifampicin versus linezolid for the treatment of MRSA infection

“…The combination of rifampicin plus trimethoprim/sulfamethoxazole is a theoretically even more attractive regimen for the treatment of MRSA infections for a number of reasons, including enhanced and intracellular antistaphylococcal activity, excellent bioavailability and favourable pharmacodynamics. 22,23 The combination is widely used in several European countries, especially for osteoarticular infections, although published evidence supporting its use remains sparse. 24,25 Moreover, since these antibiotics are available as generic agents, they offer substantial cost advantages over other agents such as linezolid and daptomycin.…”

Successful Treatment of Persistent MRSA Bacteremia using High-dose Daptomycin Combined with Rifampicin

“…RFP has been reported to be effective against biofilm-related MRSA infection in vitro (32). The efficacy of RFP for MRSA osteomyelitis was also recently demonstrated in a clinical systematic review (35), and the long-term use of RFP for such conditions is recommended in recent guidelines (10). The high level of bioavailability of RFP is well accepted, and absorption appears to be maintained, even in gastrectomized patients (36,37), although these data, which were obtained from a small number of patients 30 years ago, remain inconclusive.…”