%0 Journal Article %1 Markowitz1992 %A Markowitz, N. %A Quinn, E. L. %A Saravolatz, L. D. %D 1992 %J Ann Intern Med %K mrsa staph vancomycin antifolates bacteremia drugresistance %N 5 %P 390--398 %T Trimethoprim-sulfamethoxazole compared with vancomycin for the treatment of Staphylococcus aureus infection. %V 117 %X To compare trimethoprim-sulfamethoxazole (TMP-SMZ) and vancomycin regarding efficacy and safety in the therapy of serious Staphylococcus aureus infections.Randomized, double-blind comparative trial.A tertiary-care hospital.One hundred and one intravenous drug users hospitalized with S. aureus infection.Cure and failure rates; blood and wound cultures; minimum inhibitory and bactericidal concentrations; serum inhibitory and bactericidal titers; temperature; leukocyte count; durations of treatment and hospitalization; and toxicity.Of 228 intravenous drug users, 101 had S. aureus infection and were included in the efficacy analysis (43 received TMP-SMZ and 58 received vancomycin). Methicillin-resistant S. aureus (MRSA) accounted for 47\% of S. aureus isolates, and 65\% of patients were bacteremic. Infections were cured in 57 of 58 vancomycin recipients and in 37 of 43 TMP-SMZ recipients (P less than 0.02). Failure occurred mostly in patients with tricuspid valve endocarditis and only in those with infection caused by methicillin-sensitive S. aureus (MSSA). The mean duration of bacteremia was 6.7 days in TMP-SMZ recipients and 4.3 days in vancomycin recipients. Among 222 subjects hospitalized for at least 24 hours, toxicity rates were similar for TMP-SMZ (23\%) and vancomycin (20\%) recipients; nausea and vomiting were associated with TMP-SMZ and inflammation at the intravenous site was associated with vancomycin. Forty-four percent of TMP-SMZ recipients and 29\% of vancomycin recipients experienced side effects in the efficacy cohort (P greater than 0.05).Vancomycin is superior to TMP-SMZ in efficacy and safety when treating intravenous drug users who have staphylococcal infections. However, all treatment failures occurred in patients with MSSA infection at any site. Therefore, TMP-SMZ may be considered as an alternative to vancomycin in selected cases of MRSA infection.

@article{Markowitz1992, abstract = {To compare trimethoprim-sulfamethoxazole (TMP-SMZ) and vancomycin regarding efficacy and safety in the therapy of serious Staphylococcus aureus infections.Randomized, double-blind comparative trial.A tertiary-care hospital.One hundred and one intravenous drug users hospitalized with S. aureus infection.Cure and failure rates; blood and wound cultures; minimum inhibitory and bactericidal concentrations; serum inhibitory and bactericidal titers; temperature; leukocyte count; durations of treatment and hospitalization; and toxicity.Of 228 intravenous drug users, 101 had S. aureus infection and were included in the efficacy analysis (43 received TMP-SMZ and 58 received vancomycin). Methicillin-resistant S. aureus (MRSA) accounted for 47\% of S. aureus isolates, and 65\% of patients were bacteremic. Infections were cured in 57 of 58 vancomycin recipients and in 37 of 43 TMP-SMZ recipients (P less than 0.02). Failure occurred mostly in patients with tricuspid valve endocarditis and only in those with infection caused by methicillin-sensitive S. aureus (MSSA). The mean duration of bacteremia was 6.7 days in TMP-SMZ recipients and 4.3 days in vancomycin recipients. Among 222 subjects hospitalized for at least 24 hours, toxicity rates were similar for TMP-SMZ (23\%) and vancomycin (20\%) recipients; nausea and vomiting were associated with TMP-SMZ and inflammation at the intravenous site was associated with vancomycin. Forty-four percent of TMP-SMZ recipients and 29\% of vancomycin recipients experienced side effects in the efficacy cohort (P greater than 0.05).Vancomycin is superior to TMP-SMZ in efficacy and safety when treating intravenous drug users who have staphylococcal infections. However, all treatment failures occurred in patients with MSSA infection at any site. Therefore, TMP-SMZ may be considered as an alternative to vancomycin in selected cases of MRSA infection.}, added-at = {2013-06-05T02:24:29.000+0200}, author = {Markowitz, N. and Quinn, E. L. and Saravolatz, L. D.}, biburl = {https://www.bibsonomy.org/bibtex/202ebefd9ae7141b006f4caba52d0ff6f/aorchid}, description = {Randomized trial of IV bactrim (n=43) (320mg BID) versus vancomycin (n=58). For MSSA (n22 versus 32) t/s was worse than vanco in endocarditis (but similar for non-IE infections), but for MRSA (n=21 versus 26) they were equivalent (no failures).}, file = {:ID_General/AnnInternMed.117.390.pdf:PDF}, groups = {public}, institution = {Division of Infectious Diseases, Henry Ford Hospital, Detroit MI 48202.}, interhash = {358d8190cff4be4d21176e7aab017154}, intrahash = {02ebefd9ae7141b006f4caba52d0ff6f}, journal = {Ann Intern Med}, keywords = {mrsa staph vancomycin antifolates bacteremia drugresistance}, language = {eng}, medline-pst = {ppublish}, month = Sep, number = 5, pages = {390--398}, pmid = {1503330}, timestamp = {2013-06-05T02:24:29.000+0200}, title = {Trimethoprim-sulfamethoxazole compared with vancomycin for the treatment of Staphylococcus aureus infection.}, username = {aorchid}, volume = 117, year = 1992 }