Role of Folate Antagonists in the Treatment of Methicillin-Resistant Staphylococcus aureus Infection

Methicillin-resistant Staphylococcus aureus (MRSA) infection has reached epidemic proportions, and therapeutic options are limited because these strains are often multidrug resistant. However, the new strains of community-acquired MRSA show decreased resistance to trimethoprim-sulfamethoxazole. Clin...

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Bibliographic Details
Published in:Clinical infectious diseases 2008-02, Vol.46 (4), p.584-593
Main Authors: Goldstein, Ellie J. C., Proctor, Richard A.
Format: Article
Language:English
Subjects:
Animals
Anti-Infective Agents - pharmacology
Anti-Infective Agents - therapeutic use
Antibiotics
Bacteria
Bacterial diseases
Biological and medical sciences
Community-Acquired Infections - drug therapy
Community-Acquired Infections - microbiology
Drug resistance
Human bacterial diseases
Humans
Infectious diseases
Medical research
Medical sciences
Methicillin Resistance
Staphylococcal Infections - drug therapy
Staphylococcal Infections - microbiology
Staphylococcal infections, streptococcal infections, pneumococcal infections
Staphylococcus aureus
Staphylococcus aureus - drug effects
Trimethoprim, Sulfamethoxazole Drug Combination - pharmacology
Trimethoprim, Sulfamethoxazole Drug Combination - therapeutic use
Vitamin B
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Summary:Methicillin-resistant Staphylococcus aureus (MRSA) infection has reached epidemic proportions, and therapeutic options are limited because these strains are often multidrug resistant. However, the new strains of community-acquired MRSA show decreased resistance to trimethoprim-sulfamethoxazole. Clinical and experimental reports show a mixture of successes and failures with trimethoprim-sulfamethoxazole treatment. A reason for failure might be the amount of thymidine released from damaged host tissues and bacteria, a concept strengthened by the fact that S. aureus thermonuclease releases thymidine from DNA. Thus, success or failure with trimethoprim-sulfamethoxazole may well depend on the amount of tissue damage and organism burden, rather than acquisition of a resistance gene. Clinical trials and experimental animal studies show high failure rates, perhaps because of released thymidine. The use of trimethoprim-sulfamethoxazole for community-acquired MRSA infection should not be endorsed without further research.
ISSN:1058-4838
1537-6591
DOI:10.1086/525536