Current pharmacotherapy for methicillin-resistant Staphylococcus aureus (MRSA) pneumonia

ABSTRACT

Introduction

Currently, several antibiotics are active against methicillin-resistant Staphylococcus aureus (MRSA) and can be used for the treatment of pneumonia. They show great variability in terms of antibiotic class, indication, pharmacodynamic/pharmacokinetic properties, type of available formulations, spectrum of activity against bacteria other than MRSA, and toxicity profile.

Areas covered

In this narrative review, the authors discuss the characteristics of currently available agents for the treatment of MRSA pneumonia.

Expert opinion

The availability of different agents with anti-MRSA activity, and approved for the treatment of pneumonia can allow a personalized approach for any given patient based on the severity of the disease, the setting of occurrence, the patient’s baseline risk of toxicity and drug interactions, and the possibility of oral therapy whenever early discharge or outpatient treatment are possible. Although some gray areas still remain, like the lack of high certainty evidence on the efficacy of some old agents and on the precise role of companion agents with toxin inhibitory activity in the case of necrotizing pneumonia, the frequent availability of different treatment choices, each with peculiar characteristics, is already allowing an important step toward a precision medicine approach for the treatment of MRSA pneumonia.

KEYWORDS:

• Linezolid
• vancomycin
• delafloxacin
• lefamulin
• omadacycline
• ceftobiprole
• ceftaroline
• clindamycin
• rifampin
• minocycline

Article highlights

• Pneumonia caused by MRSA continues to carry a high burden in terms of mortality, both when developing in the community and when occurring in hospitalized patients

• Several antibiotics can be used for the treatment of MRSA pneumonia, which show great variability in terms of antibiotic class, indication (CAP, HAP, and VAP), PK/PD properties, type of available formulations, spectrum of activity, and toxicity profile

• The availability of different agents can allow a tailored approach for any given patient based on the severity of the disease, the setting of occurrence, the patient’s baseline risk of toxicity and drug interactions, and the possibility of oral therapy whenever early discharge or outpatient treatment is possible

• The frequent availability of different treatment choicesis allowing an important step toward a precision medicine approach to the treatment of MRSA pneumonia.

• Among the remaining gray areas to be highlighted, there is a lack of high certainty evidence on the efficacy of some old agents and on the precise role of companion agents with toxin inhibitory activity in the case of necrotizing pneumonia.

Declaration of interest

M Bassetti has received funding for scientific advisory boards, travel, and speaker honoraria from Angelini, Astellas, AstraZeneca, Basilea, Bayer, BioMérieux, Cidara, Correvio, Cubist, Menarini, Molteni, Merck Sharp and Dohme, Nabriva, Paratek, Pfizer Inc, Roche, Shionogi, Tetraphase, Thermo Fisher Scientific, and The Medicine Company. Meanwhile, DR Giacobbe reports honoraria from Stepstone Pharma GmbH and unconditional grants from Merck Sharp and Dohme Italia, Correvio Italia, and Pfizer Inc. 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 in this manuscript have no relevant financial or other relationships to disclose.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This work was not funded.