Antimicrobial prescribing for treatment of serious infections caused by Staphylococcus aureus and methicillin-resistant Staphylococcus aureus in pediatrics: an expert review

ABSTRACT

Introduction: Staphylococcus aureus, including methicillin-resistant S. aureus (MRSA), remains a significant pathogen in children. Despite evidence of decreasing prevalence, MRSA bacteremia has been closely associated with complications, including certain infections (i.e. musculoskeletal and endovascular) linked to increased treatment failures.

Areas covered: This expert review summarized recent published literature on the role of treatment, dosing and administration of antibiotics used to combat serious S. aureus infections in children. The pertinent antibiotics presented were vancomycin, oxazolidinones, semi-synthetic glycopeptides, daptomycin, tigecycline, novel cephalosporins, fosfomycin and lefamulin. Vancomycin has been the most commonly used antibiotic in empiric therapy for serious MRSA infection, with new key recommendations emphasizing a different approach to dosing and therapeutic monitoring. For other antibiotics, data remain limited or clinical trials are underway.

Expert opinion: MRSA remains a significant pathogen in the pediatric population. As numerous therapeutic agents are available, many agents have limited data on usage in pediatric patients. Future studies require pharmacokinetic, safety and efficacy studies in pediatric patients to ensure appropriate therapeutic treatment and outcomes. Phage therapy has been used to treat deep-seated MRSA infections and is an emerging investigational treatment option.

KEYWORDS:

• Staphylococcus aureus
• mrsa
• antibiotics
• pediatrics
• treatment

Article highlights

• Staphylococcus aureus (including serious MRSA) infections remains a relevant pathogen in children

• This review summarizes literature on the dosing and administration of antibiotics used to treat serious Staphylococcus aureus infections in children

• Antibiotics covered include vancomycin, oxazolidinones, semi-synthetic glycopeptides, daptomycin, tigecycline, novel cephalosporins, fosfomycin and lefamulin

• Vancomycin is still the most commonly used antibiotic as empiric therapy for serious MRSA infection

• Future studies on newer agents require pharmacokinetic, safety and efficacy studies in pediatric patients

Declaration of interest

JS Bradley’s employer, the University of California, has research and/or consulting agreements for clinical trials during the past 12 months with NIH, Cubist/Merck, Actavis/Allergan, AstraZeneca, Cumberland, Janssen, The Medicines Company/Melinta, Pfizer, Shionogi, Zavante/Nabriva, GSK. NJ Rhodes has received research funds from Paratek unrelated to the present study. 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. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

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

Additional information

Funding

This paper was not funded.