Important new therapies for methicillin-resistant Staphylococcus aureus

ABSTRACT

Introduction: Methicillin-resistant Staphylococcus aureus (MRSA) infections represent a leading cause of infection-related morbidity and mortality worldwide. There has been a welcome increase in the number of agents available for the treatment of MRSA infection over the last decade and several clinical trials are currently investigating the role of new experimental strategies.

Areas covered: The purpose of this manuscript is to review the efficacy and safety of recently approved anti-MRSA molecules as well as some newer agents currently under investigation with a specific focus on the potential role of these drugs in everyday clinical practice.

Expert opinion: Many new drugs with an activity against MRSA have been recently approved or are in an advanced stage of development. All these compounds represent promising options to enhance our antibiotic armamentarium. However, data regarding the use of these new compounds in real-life terms are limited and their best placement in therapy and in terms of optimization of medical resources and balance of cost-effectiveness requires further investigation.

KEYWORDS:

• S.aureus
• MRSA
• dalbavancin
• ceftaroline
• delafloxacxin
• plazomicin

Declaration of interest

M Bassetti has participated in advisory boards and/or received speaker honoraria from Achaogen, Angelini, Astellas, Bayer, Basilea, Biomerieux, Cidara, Gilead Sciences, Menarini, Merck Sharp and Dohme, Nabriva, Paratek, Pfizer, Roche, Melinta, Shionogi, Tetraphase, VenatoRx and Vifor and has received study grants from Angelini, Basilea, Astellas, Shionogi, Cidara, Melinta, Gilead, Pfizer and Merck Sharp and Dohme. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Article highlights

• A number of novel and potent agents have recently enriched the anti-MRSA armamentarium with unprecedented features from oral formulations, long lifespans, an overall favorable safety profile, a large spectrum oriented to poly-microbial infections, and good tissue penetration with some molecules.

• Although novel anti MRSA molecules have originally been investigated for the treatment of skin and soft tissue infections and pneumonia, their role may also become crucial with infections, such as complicated bacteremia, endocarditis, and osteomyelitis.

• Novel cefalosporins, fluoroquinoles, and tetracycline-derivatives also represent good and broad anti-Gram negative agents, while maintaining a good safety profile.

• New oxazolidinones overcome the limits of their ‘old’ cousin linezolid regarding toxicity and pharmacological interactions.

• Long-acting antimicrobials could represent a cost-saving option to guarantee outpatient treatment with difficult-to-treat infections.

• Notwithstanding the emergence of a number of randomized controlled trials evaluating these novel agents in the setting of bacteremia and endocarditis, the lack of experimental studies in the setting of critically ill patients and special populations represents a major unmet need.

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Additional information

Funding

This manuscript was not funded.