Efficacy of a combined oral clindamycin–rifampicin regimen for therapy of staphylococcal osteoarticular infections

Czekaj, Jaroslaw; Dinh, Aurélien; Moldovan, Andreea; Vaudaux, Pierre; Gras, Guillaume; Hoffmeyer, Pierre; Lew, Daniel Pablo; Bernard, Louis; Uçkay, İlker

doi:10.3109/00365548.2011.608082

Cited by 34 publications

(21 citation statements)

References 31 publications

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“…It inhibits production of S. aureus toxins (Otto et al 2013), additionally to the exhibition of its antibacterial activity. Combination of clindamycin with rifampin has also been suggested (Czekaj et al 2011), but recent pharmacokinetic studies demonstrated dramatic reduction of clindamycin serum concentration if combined with rifampin (Bernard et al 2015a;Join-Lambert et al 2014). Therefore, caution is recommended regarding this combination until more data become available.…”

Section: Antimicrobial Treatmentmentioning

confidence: 99%

Staphylococcus aureus-Associated Musculoskeletal Infections

Idelevich

Kreis

Löffler

et al. 2016

Current Topics in Microbiology and Immunology

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Musculoskeletal infections caused by Staphylococcus aureus are among the most difficult-to-treat infections. S. aureus osteomyelitis is associated with a tremendous disease burden through potential for long-term relapses and functional deficits. Although considerable advances have been achieved in diagnosis and treatment of osteomyelitis, the management remains challenging and impact on quality of life is still enormous. S. aureus acute arthritis is relatively seldom in general population, but the incidence is considerably higher in patients with predisposing conditions, particularly those with rheumatoid arthritis. Rapidly destructive course with high mortality and disability rates makes urgent diagnosis and treatment of acute arthritis essential. S. aureus pyomyositis is a common disease in tropical countries, but it is very seldom in temperate regions. Nevertheless, the cases have been increasingly reported also in non-tropical countries, and the physicians should be able to timely recognize this uncommon condition and initiate appropriate treatment. The optimal management of S. aureus-associated musculoskeletal infections requires a strong interdisciplinary collaboration between all involved specialists.

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Section: Antimicrobial Treatmentmentioning

confidence: 99%

Staphylococcus aureus-Associated Musculoskeletal Infections

Idelevich

Kreis

Löffler

et al. 2016

Current Topics in Microbiology and Immunology

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“…In vitro, clindamycin prevents the emergence of rifampin resistance, and the combination displayed synergetic or additive bactericidal activity, as well as favorable cure rates in animal models [13–18]. To date, only 2 case series have reported on the efficacy of an oral clindamycin-rifampin combination therapy regimen for staphylococcal PJI in adults, with a success rate of 70% in 7 cases and 100% in 6 cases [6, 19]. …”

Section: Introductionmentioning

confidence: 99%

Clindamycin-rifampin combination therapy for staphylococcal periprosthetic joint infections: a retrospective observational study

et al. 2017

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BackgroundStaphylococcal species account for more than 50% of periprosthetic joint infections (PJI) and antimicrobial therapy with rifampin-based combination regimens has been shown effective. The present study evaluates the safety and efficacy of clindamycin in combination with rifampin for the management of staphylococcal PJI.MethodsIn this retrospective cohort study, patients were included who received clindamycin-rifampin combination therapy to treat a periprosthetic hip or knee infection by Staphylococcus aureus or coagulase-negative staphylococci. Patients were treated according to a standardized treatment algorithm and followed for a median of 54 months.Of the 36 patients with periprosthetic staphylococcal infections, 31 had an infection of the hip, and five had an infection of the knee. Eighteen patients underwent debridement and retention of the implant (DAIR) for an early infection, the other 18 patients underwent revision of loose components in presumed aseptic loosening with unexpected positive cultures.ResultsIn this study, we report a success rate of 86%, with five recurrent/persistent PJI in 36 treated patients. Cure rate was 78% (14/18) in the DAIR patients and 94% (17/18) in the revision group. Five patients (14%) discontinued clindamycin-rifampin due to side effects. Of the 31 patients completing the clindamycin-rifampin regimen 29 patients (94%) were cured.ConclusionCombined therapy with clindamycin and rifampin is a safe, well tolerated and effective regimen for the treatment of staphylococcal periprosthetic infection.

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“…In addition, another benefit of combination treatment is the possibility of a synergistic effect between two antibiotics given together. Oral antibiotics proposed for combination therapy with rifampicin in order to reduce the risk of emerging resistance include fluoroquinolones , clindamycin , fusidic acid , trimethoprim‐sulphamethoxazole , and linezolid . It is recommended to avoid combining rifampicin with beta‐lactam or glycopeptide antibiotics, as rapid emergence of resistance to rifampicin has been observed using these combinations .…”

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confidence: 99%

Antibiotic susceptibility among Staphylococcus epidermidis isolated from prosthetic joint infections, with focus on doxycycline

Hamad

Hellmark

Nilsdotter-Augustinsson

et al. 2015

APMIS

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In recent years, coagulase-negative staphylococci such as Staphylococcus epidermidis have gained importance as nosocomial pathogens, especially in immunocompromised patients and prosthetic joint infections (PJIs). These infections are often long lasting and difficult to treat due to the production of bacterial biofilm and the transformation of the bacteria into a stationary growth phase. Rifampicin is able to penetrate the biofilm, but to reduce the risk of development of rifampicin resistance it should be used in combination with an additional antibiotic. In this study we used Etest to investigate the antimicrobial susceptibility of 134 clinical isolates of S. epidermidis obtained from PJIs to six oral antibiotics: doxycycline, rifampicin, linezolid, fusidic acid, clindamycin, and ciprofloxacin. We also performed synergy testing on doxycycline in combination with each of the remaining antibiotics. Ninety-three (69%) of the 134 isolates were susceptible to doxycycline, 94/134 (70%) to rifampicin, 56/134 (42%) to clindamycin, 25/134 (19%) to ciprofloxacin, 81/134 (60%) to fusidic acid, and 100% to linezolid. Thirty-two (80%) of the 40 isolates not fully susceptible to rifampicin were susceptible to doxycycline. Doxycycline in combination with each of the other investigated antibiotics exerted an additive effect on nearly half of the isolates, with the exception of clindamycin, which displayed an even higher percentage of additive effect (69%). To conclude, as the majority of the S. epidermidis isolates were susceptible to doxycycline, this antimicrobial agent may provide a potential alternative for combination therapy together with rifampicin.

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Efficacy of a combined oral clindamycin–rifampicin regimen for therapy of staphylococcal osteoarticular infections

Cited by 34 publications

References 31 publications

Staphylococcus aureus-Associated Musculoskeletal Infections

Staphylococcus aureus-Associated Musculoskeletal Infections

Clindamycin-rifampin combination therapy for staphylococcal periprosthetic joint infections: a retrospective observational study

Antibiotic susceptibility among Staphylococcus epidermidis isolated from prosthetic joint infections, with focus on doxycycline

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