Table 1.
Summary of advantages and disadvantages for various drug classes involved in the treatment of MRSA infections [59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86,87,88,89,90,91,92,93,94,95,96,97,98,99,100,101,102,103,104,105,106,107,108,109,110,111,112,113,114,115,116,117,118,119,120,121,122,123,124,125,126,127,128,129,130,131,132,133,134,135,136,137,138,139,140,141,142,143,144,145,146,147,148,149,150,151,152,153,154,155,156,157,158,159,160,161,162,163,164,165,166,167,168,169,170,171,172,173,174,175,176,177,178,179,180,181,182,183,184,185].
| Antibiotic Class (with Examples) | Advantages Indications (in Italics) | Disadvantages |
|---|---|---|
| SMX/TMP | Available for oral and parenteral use Good tolerability Price of therapy Wide range of indications |
Resistance levels iv. infusion has to be administered in a large volume of fluid |
| Tetracyclines/Glycylcyclines (doxycycline, tygecycline) | Broad spectrum activity Wide range of indications (tigecycline: SSTIs, cIAI, CAP) |
Doxycycline: resistance levels Tygecycline: black box warning, iv. only Severe nausea and vomiting (dose-limiting side effect) |
| Novel tetracycline-derivatives (eravacycline, omadacycline) | Broad spectrum activity CAP, SSTIs |
Severe nausea and vomiting (dose-limiting side effect) Parenteral only Resistance expression/horizontally transmitted resistance genes |
| Glycopeptides (vancomycin, teicoplainin) | Gold standard of MRSA-therapy for a long time Extensive clinical data available regarding its usePrice of therapy Wide range of indications |
MIC creep Parenteral only (with exceptions) TDM required (due to nephrotoxicity and ototoxicity) Resistance expression (hVISA, VISA, VRSA) |
| Lipoglycopeptides (telavancin, dalbavancin, oritavancin) | Long half-life (single-dose therapy) Useful in OPAT There is no need for TDM SSTIs, bone and joint infections HAP, VAP (telavancin) |
Parenteral only Price of therapy Cannot be removed by dialysis Increased mortality in renal insufficiency Resistance expression/horizontally transmitted resistance genes |
| Oxazolidinones (linezolid, tedizolid) | Available for oral and parenteral use SSTIs, bone and joint infections |
Drug-drug interactions MAO-inhibition (Serotonin-syndrome) Price of therapy Resistance expression/horizontally transmitted resistance genes |
| Lipopeptides (daptomycin) | Bloodstream infections, infective endocarditis, SSTIs | Not useful in pneumonia Parenteral only Resistance expression/horizontally transmitted resistance genes |
| 5th generation cephalosporins (ceftaroline, ceftobiprole) | Good tolerability SSTIs, CAP, HAP, MRSA bacteremia |
Price of therapy Hydrolized by ESBLs (mixed infections) Resistance expression/horizontally transmitted resistance genes |
| Older fluoroquinolones (ciprofloxacin, levofloxacin, moxifloxacin) | Available for oral and parenteral use Extensive clinical data available regarding their use Good tolerability Accumulation in the intracellular space Price of therapy Broad-spectrum activity Wide range of indications |
Side effect profile (especially in light of recent developments) Resistance levels and rapid resistance development |
| Next-generation fluoroquinolones (delafloxacin; avarofloxacin, finafloxacin, zaborfloxacin, nemonoxacin) | Available for oral and parenteral use Broad-spectrum activity Accumulation in the intracellular space Presently studied in a wide range of indications (e.g., cSSTI, CAP, HAP, cUTI MDR gonorrhea) |
Black box warining Side effect profile Price of therapy |
| Mupirocin | Price of therapy Dose-dependent bactericidal activity Topical agent for MRSA nasal decolonization Additonal indications are being studied |
Resistance development Risk of toxicity when used orally/parenterally |