Pharmacotherapeutic options for treating Staphylococcus aureus bacteremia

ABSTRACT

Introduction: Case-fatality rates for Staphylococcus aureus bacteremia (SAB) remain unacceptably high and have improved only modestly in recent decades. Treatment of SAB is still a clinical challenge, especially if methicillin-resistant strains are involved. New drugs with anti-staphylococcal activity are currently available, and their role as alternatives to standard therapies is being investigated.

Areas covered: In this review, we give an update of the current available antibiotics for the treatment of SAB. We provide information regarding the pharmacological characteristics, the accepted indications, and the most important adverse events of the old and new anti-staphylococcal agents, as well as the existing evidence on their use for the treatment of SAB.

Expert opinion: The management of patients with SAB is very complex and needs a multidisciplinary approach. There are currently new available options for the treatment of methicillin-resistant SAB. However, more data from clinical trials are needed to assign specific roles to each antibiotic and to include them in the new antibacterial armamentarium. The role of combination therapy for the treatment of increasingly complex patients with SAB deserves thorough investigation.

KEYWORDS:

• Bacteraemia
• bloodstream infection
• ceftaroline
• ceftobiprole
• cephazolin
• clindamycin
• cotrimoxazole
• dalvabancin
• daptomycin
• fosfomycin
• linezolid
• methicillin-resistant Staphylococcus aureus
• methicillin-susceptible Staphylococcus aureus
• tedizolid
• tigecycline
• teicoplanin
• telavancin
• oritavancin
• vancomycin

Article highlights

• Current patients with SAB are elderly, with several comorbidities and an increased risk for complicated bacteremia and poor outcome.

• Patients with SAB require early adequate support and antimicrobial therapy, as well as source control and involvement of an infectious diseases specialist.

• Cefazolin is a reliable alternative to penicillinase-stable penicillins for the treatment of methicillin-susceptible SAB

• Ceftaroline has been mainly used as salvage therapy, and its usefulness as first-line therapy needs to be established.

• The new lipoglycopeptides are promising drugs with an attractive posology profile, but their experience in bacteremia is limited.

• Randomized clinical trials assessing the usefulness of combination therapy in the non-salvage setting are warranted, especially in patients with MRSA infections.

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Declaration of interest

The authors have no 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.

Additional information

Funding

This paper did not receive any funding