Where’s the combo drugs for MRSA?

MRSA is the latest major problem to be dealt with in medicine.  Of the usual bugs that cause cellulitis and abscesses of the skin, this one has been pressured (by docs giving antibiotics) into becoming resistant (Methicillin-resistant Staphylococcus aureus).  Something that was an ICU problem four years ago is now an everyday problem here.

The recommended treatment is now to give two drugs, which (so far) the bacteria cannot deal with effectively.  There are several recommended combinations, and apparently they work well.

So, where are the ‘combo’ antibiotics?  This would seem to be a place where a pill combining the two drugs together in one pill would be more effective (better compliance, etc).  I’m not in the pharmaceutical manufacturing world, and wonder if this would have to basically be a new med and go through every single FDA hurdle, or if it’s a bit simpler than that.

I’ll add some links to the above after my shift.


  1. TheNewGuy says:

    We get gobs of commmunity-acquired MRSA… a lot of it in young people who have never spent a day in a healthcare facility.

    Big problem… no good answer.

    BTW, what is yours susceptible to? Ours dies in response to Vanc, Bactrim and Rifampin; it shrugs off everything else.

  2. We use a lot of bactrim and rifampin; also, clinda and (nearly anything).

  3. HM3 Heidrich says:

    We saw a rash of MRSA through our BAS post dep to OIF II.. i think we were killing it with Ancef IV and Keflex (? Id have to double check with our IDC) whats your preference?

    HM3 Heidrich
    3Bn / 7th Marines BAS

  4. My personal preference is BactrimDS and Rifampin. Cheap and effective.

  5. Ryan Maves says:

    HM2 – If it was responding to Ancef and Keflex, then it almost definitely wasn’t MRSA. The Marines are definitely crawling with the stuff, though…MCRD San Diego is a one of early hotspots.

    Bactrim and rifampin is a great combo. Wouldn’t want to use rifampin alone (resistance emerges rapidly). I lean towards Bacrim and minocycline around here, since rifampin tends to stain orange the contact lenses of patients on it, but of course your choices need to be dictated by local susceptibility patterns. Plus that minocycline vertigo thing pops up every now and then.

  6. I just use Bactrim. BTW, Community aquired MRSA is not the same strain that has simply escaped from the health care industry, it is it’s own monster, born of and modified by the (non-healthcare) community in general. Showing that multiple strains will eventually respond in a similar way to similar pressures.

  7. Bad Shift says:

    I have been using Bactrim and Rifampin, but just learned at dept. meeting that most others are going with Bactrim single coverage? Any data?

  8. cardioNP says:

    When I managed a subacute ward in a VA Hospital, ID always recommended 2 drug tx – either Rif and doxy or Rif and TMP/SMX as Grunt Doc has suggested. But ID did call the lab to confirm that the bug was bactrim and/or tetracycline susceptible.
    Since both drugs are generic, I doubt that any company would spend the money to get FDA approval for a combo drug – most healthcare agencies would probably not approve the expensive combo. Though compliance probably would be better.

  9. With a prepackaged combination you create a nice constant selection pressure in the same way that led to MRSA in the first place. By keeping the drugs separate, you have the chance of varying the regimen from time to time, and possibly also from place to place. That should stop any one mechanism of resistance from becoming dominant thus keeping the bugs on the defensive. Regarding the regulatory issues, I would imagine it’s not just a reformulation, so no doubt the FDA would demand trial data.

  10. Susan Pesek says:

    I use IV Zyvox and IV Riphampin. After IV, PO of Bactrim.

  11. gerrie kim says:

    well what about tygacil?

  12. Well, it’s not a combo drug, it’s a very new and therefore expensive, IV only, drug.


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