The increasing emergence of antimicrobial-resistant organisms, especially methicillin-resistant Staphylococcus aureus (MRSA), has resulted in the increased use of
rifampin combination
therapy. The data supporting
rifampin combination
therapy in nonmycobacterial
infections are limited by a lack of significantly controlled clinical studies. Therefore, its current use is based upon in vitro or in vivo data or retrospective case series, all with major limitations. A prominent observation from this review is that
rifampin combination
therapy appears to have improved treatment outcomes in cases in which there is a low organism burden, such as biofilm
infections, but is less effective when effective surgery to obtain source control is not performed. The clinical data support
rifampin combination
therapy for the treatment of prosthetic joint
infections due to
methicillin-sensitive S. aureus (MSSA) after extensive
debridement and for the treatment of prosthetic heart valve
infections due to
coagulase-negative staphylococci. Importantly,
rifampin-
vancomycin combination
therapy has not shown any benefit over
vancomycin monotherapy against MRSA
infections either clinically or experimentally.
Rifampin combination
therapy with
daptomycin,
fusidic acid, and
linezolid needs further exploration for these severe MRSA
infections. Lastly, an assessment of the risk-benefits is needed before the addition of
rifampin to other antimicrobials is considered to avoid drug interactions or other
drug toxicities.