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[Treatment of severe staphylococcal infections. Failure of rifampicin in combination therapy. 4 cases].

Abstract
Seven patients with severe methicillin-resistant Staphylococcus aureus infections (5 with bacterial endocarditis, 1 with mediastinitis and 1 with meningitis and septicaemia) were treated with rifampicin combined with vancomycin in 6 cases and with gentamicin in 1 case. The 7 strains initially isolated from haemocultures were resistant to methicillin and sensitive to rifampicin. In 4 of these patients (3 of whom received vancomycin and 1 gentamicin) clinical and bacteriological failure was observed, with selection of rifampicin-resistant mutants. Bactericidal activity was always mediocre in both serum and cerebrospinal fluid, with insufficient vancomycin and gentamicin concentrations in 3 patients. An in vitro study of the combined antibiotics by the chequer-board method suggested antagonism in 3 of these 4 cases. Thus, in spite of its excellent activity and unquestionable effectiveness, rifampicin should be used with caution in severe staphylococcal infections.
AuthorsJ J Garaud, B Regnier, K Lassoued, B Pangon, C Leport
JournalPresse medicale (Paris, France : 1983) (Presse Med) Vol. 14 Issue 18 Pg. 1013-6 (May 04 1985) ISSN: 0755-4982 [Print] France
Vernacular TitleTraitement des staphylococcies graves. Echecs de la rifampicine en association. Quatre observations.
PMID3158945 (Publication Type: English Abstract, Journal Article)
Chemical References
  • Anti-Bacterial Agents
  • Rifampin
Topics
  • Anti-Bacterial Agents (metabolism, therapeutic use)
  • Drug Antagonism
  • Drug Resistance, Microbial
  • Drug Therapy, Combination
  • Humans
  • Rifampin (metabolism, therapeutic use)
  • Staphylococcal Infections (drug therapy)

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