Trimethoprim-sulfamethoxazole compared with vancomycin for the treatment of Staphylococcus aureus infection.

Authors

Markowitz N, Quinn EL, Saravolatz LD 

Institution

Division of Infectious Diseases, Henry Ford Hospital, Detroit MI 48202.

Source

Ann Intern Med 1992 Sep 1; 117(5) :390-8.

Abstract

OBJECTIVE
To compare trimethoprim-sulfamethoxazole (TMP-SMZ) and vancomycin regarding efficacy and safety in the therapy of serious Staphylococcus aureus infections.
DESIGN
Randomized, double-blind comparative trial.
SETTING
A tertiary-care hospital.
PATIENTS
One hundred and one intravenous drug users hospitalized with S. aureus infection.
MEASUREMENTS
Cure and failure rates; blood and wound cultures; minimum inhibitory and bactericidal concentrations; serum inhibitory and bactericidal titers; temperature; leukocyte count; durations of treatment and hospitalization; and toxicity.
RESULTS
Of 228 intravenous drug users, 101 had S. aureus infection and were included in the efficacy analysis (43 received TMP-SMZ and 58 received vancomycin). Methicillin-resistant S. aureus (MRSA) accounted for 47% of S. aureus isolates, and 65% of patients were bacteremic. Infections were cured in 57 of 58 vancomycin recipients and in 37 of 43 TMP-SMZ recipients (P less than 0.02). Failure occurred mostly in patients with tricuspid valve endocarditis and only in those with infection caused by methicillin-sensitive S. aureus (MSSA). The mean duration of bacteremia was 6.7 days in TMP-SMZ recipients and 4.3 days in vancomycin recipients. Among 222 subjects hospitalized for at least 24 hours, toxicity rates were similar for TMP-SMZ (23%) and vancomycin (20%) recipients; nausea and vomiting were associated with TMP-SMZ and inflammation at the intravenous site was associated with vancomycin. Forty-four percent of TMP-SMZ recipients and 29% of vancomycin recipients experienced side effects in the efficacy cohort (P greater than 0.05).
CONCLUSIONS
Vancomycin is superior to TMP-SMZ in efficacy and safety when treating intravenous drug users who have staphylococcal infections. However, all treatment failures occurred in patients with MSSA infection at any site. Therefore, TMP-SMZ may be considered as an alternative to vancomycin in selected cases of MRSA infection.

Mesh

Adult
Bacteriophage Typing
Double-Blind Method
Female
Humans
Male
Methicillin Resistance
Microbial Sensitivity Tests
Prospective Studies
Staphylococcal Infections
Substance Abuse, Intravenous
Treatment Outcome
Trimethoprim-Sulfamethoxazole Combination
Vancomycin

Language

eng

Pub Type(s)

Clinical Trial Comparative Study Journal Article Randomized Controlled Trial Research Support, Non-U.S. Gov't

PubMed ID

1503330