10. Pharmaceutical Antibiotics

Synthetic commercial antibiotics may be somewhat powerful...but at a cost. At the very least, they will indiscriminately kill off healthy gut flora too, lowering overall immunity and possibly leading to yeast (Candida) infections. At the worst, they can also cause some very severe side effects, not totally eradicate the Staph and only breed further induced resistance.

So, it is important to do your homework and be prepared for any potential side effects in advance. Because once you start a course (typically 10 days), you should finish it all the way through. These pharmaceutical drugs are all or nothing. Otherwise, you may simply kill off all the weaker bugs and leave the stronger ones behind! Not good!

Also keep in mind that MRSA is, by definition, resistant to many antibiotics. So, regardless of toxicity, they may also simply not work that well, either.

MRSA is a type of S. areus that is resistant to antibiotics called beta-lactams. Beta-lactam antibiotics include methicillin and other more common antibiotics such as oxacillin, penicillin and amoxicillin.

Most healthcare-associated MRSA (HA-MRSA) are also resistant to macrolides, fluoroquinolones, clindamycin, and trimethoprim/sulfamethoxazole

CA-MRSA strains are generally susceptible to a wider range of antibiotics (e.g., usually susceptible to fluoroquinolones and trimethoprim/sulfamethoxazole [TMP/SMX]) and some CA-MRSA carry genes encoding toxins and virulence factors (e.g. Pantone-Valentine leukocidin)

That said, if you have a fast-spreading infection that has gone internally septic (often seen with large, red, spreading streaks) - you may have to "cut your nose to save your face" just to at least buy yourself some time. When presented with limited options, you may simply have to choose your lesser of evils...

So, it's always good to keep all your options open and make your own personal choices. And at least make a better-informed decision, if you do choose to try this route.

Sulfamethoxazole (Bactrim, Septra):

trimethoprim / sulfamethoxazole, probably the best choice of the affordable medications when an oral antibiotic is needed. "Sulfamethoxazole covers most MRSA,"

Trimeth/sulfa monotherapy may be effective in treating MRSA

"If you give sulfa first line ... willy-nilly to everyone who steps into an ED with a skin infection, you are going to give someone a bad sulfa rash."

serious risks and side-effects from this antibiotic, marketed under many names, including Bactrim, Bactrim DS, Septra, Septra DS, Septrin, Sulfatrim, SMZ/TMP, Septran and co-trimoxazole

Clindamycin:

Treat with clindamycin rather than TMP/SMX if streptococcal infection is in the differential diagnosis. However, some MRSA isolates can become resistant to clindamycin while on therapy (i.e., inducible clindamycin resistance) and this should be suspected if a CA-MRSA isolate is erythromycin-resistant.

It is also used to treat bone and joint infections, particularly those caused by Staphylococcus aureus.

many strains of MRSA are still susceptible to clindamycin; however, in the United States spreading from the West Coast eastwards, MRSA is becoming increasingly resistant.

The most severe common adverse effect of clindamycin is Clostridium difficile-associated diarrhea (the most frequent cause of pseudomembranous colitis). Although this side effect occurs with almost all antibiotics, including beta-lactam antibiotics, it is classically linked to clindamycin use.

If you really need antibiotics, use Clindamyacin if your MRSA responds to it. The microbiologist I spoke to about MRSA said it's one of the very few antibiotics that enter human cells to get the infection there.

If you can't use Clindamyacin (it is more expensive), take Bactrim or Septra with the milk thistle. It will help it get into the cell and work there.

Rifampin:

Rifampin, an older antibiotic usually used as part of multidrug therapy for tuberculosis, is ineffective as staphylococcal single-drug therapy. When used in combination with other antibiotics with Gram-positive activity, it improves their cure rates.

rifampin monotherapy is not recommended, some clinicians add the agent in combination with other antimicrobials

Rifampin, which kills bacteria by inhibiting DNA-dependent RNA polymerase
although it is ineffective single-drug therapy for treating staphylococcal infections, numerous studies have shown that when rifampin is combined with vancomycin, trimethoprim-sulfamethoxazole (trimeth/sulfa), minocycline, or ciprofloxacin, the resulting in vivo synergy markedly improves clinical outcomes.
Because rifampin is eliminated by the liver, reduced doses may be needed if the patient has elevated liver enzymes.

For the treatment of nonserious skin and wound infections, trimeth/sulfa and rifampin combination therapy may be an alternative to vancomycin in patients of all ages. (7,8) For adults who have sulfa allergies or who have isolates that test trimeth/sulfa-resistant, minocycline plus rifampin may be an efficacious vancomycin alternative.

in every study published to date, whenever rifampin has been combined with any of the discussed antibiotics, clinical outcomes have been improved. To date, there have been no studies published in which rifampin clinical antagonism has been observed.

Minocycline:

Minocycline, a tetracycline with unusual clinical efficacy against S aureus, is contraindicated in pregnant and pediatric patients. It must be taken with a full glass of water, and the pills must be swallowed whole to avoid esophagitis.

Daptomycin (Cubicin):

Cubicin infusion contains the active ingredient daptomycin, which is a medicine used to treat infections with bacteria, in particular Staphylococcus aureus bacteria. Daptomycin is a new type of antibiotic known as a lipopeptide antibiotic. It can only be used to treat infections with a specific sub-group of bacteria called Gram positive bacteria.

Daptomycin works by binding to the cell membranes of Gram positive bacteria, causing them to lose potassium. This causes a reaction that rapidly stops the bacteria making proteins and genetic material that they need to survive and multiply. This kills the bacteria and treats the infection.

Daptomycin has a different mechanism of action to all the other classes of antibiotics. This means it can be used to treat Gram positive bacterial infections that are resistant to other antibiotics. An example of this is infection with the "superbug" MRSA (methicillin-resistant staphylococcus aureus). Such bacterial infections have become more common, particularly in hospitals, due to increasing resistance of bacteria to antibiotic treatment. As daptomycin works in a different way to other antibiotics, it may provide doctors with a new line of attack for these types of infections. Other types of antibiotics may be used at the same time as treatment with daptomycin, if necessary.

Daptomycin is a newly-approved antibacterial agent, the first lipopeptide agent to be released onto the market. Its spectrum of activity is limited to Gram-positive organisms, including a number of highly resistant species (MRSA, VISA, VRSA, VRE). It appears to be more rapidly bactericidal than vancomycin.

Iclaprim:

intravenous iclaprim, a novel antibiotic, showed high clinical cure rates which were similar to those of the comparator drug, linezolid, in the treatment of complicated skin and skin structure infections (cSSSI) caused by Gram-positive bacteria, including methicillin-resistant Staphylococcus aureus (MRSA).

Vancomycin:

Treat with IV vancomycin (or linezolid) for severe skin infection caused by CA-MRSA, or any evidence of invasive disease

despite its in vitro activity, when vancomycin is used as single-drug therapy to treat MRSA infections, cure rates in serious infections have been very disappointing. Sakoulas (3) has reported 44% failures in treating bacteremia, and Moise and Schentag (4) have shown 40% failures in treating lower respiratory-tract infections.
a patient for whom vancomycin is prescribed must wear an infusaport around the clock
To avoid toxicity, blood levels must be monitored. Vancomycin drug acquisition, administration, and laboratory costs are approximately $100 per day.

Vancomycin is an antibiotic to which staphylococcal resistance is rare. It is eliminated through the kidneys. To prevent nephrotoxicity and ototoxicity, monitoring of serum levels is highly recommended.

Red Man Syndrome (RMS) is a commonly observed adverse drug event associated with vancomycin therapy. It is characterized by a sudden and/or profound drop in blood pressure, a maculopapular rash, angioedema, pruritus, erythema, wheezing, or dyspnea . Any or all of these effects may be seen. While rare, changes in blood pressure have been severe enough to produce cardiovascular collapse. The reaction may occur within a few minutes of starting an IV infusion of vancomycin

Linezolid (Zyvox):

The lincosamides, linezolid (Zyvox), and vancomycin are also choices, but "linezolid is exquisitely expensive and can cause reversible thrombocytopenia," Dr. Elston said. "It is an oral drug than can outdo [intravenous] vancomycin, but it is already being overused so we are seeing resistance emerging." He estimated the cost for a 1-week supply at $1,000.

Most MRSA isolates test sensitive to linezolid, an oral drug that is usually well tolerated, but which carries a risk of hematological abnormalities, including myelosuppression and thrombocytopenia. Linezolid costs $120 per day (i.e., $1,200 for a 10-day course).

Tygacil:

proven efficacy of Tygacil as monotherapy in complicated skin and skin structure infections (cSSSI) and complicated intra-abdominal infections (cIAI)

Telavancin:

At clinically attainable concentrations, telavancin was active against bacteria embedded in biofilm (minimal biofilm eradication concentration [MBEC] 0.125 to 2µg/mL), and inhibited biofilm formation at concentrations below the MIC. Vancomycin did not demonstrated the same activity (MBEC ≥512µg/mL) against S. aureus and Enterococcus. Telavancin may have a unique role in biofilm-associated infections.

Tigecycline:

Tigecycline is the first of a new class of antimicrobial agents, the glycylcyclines, which are structurally derived from the tetracycline nucleus. Tigecycline possesses activity against Gram-positive and -negative pathogens, binding to the 30S ribosomal subunit and inhibiting protein synthesis (Bouchillon et al., 2005). Tigecycline does not demonstrate co-resistance with known mechanisms of resistance, including tetracycline resistance (Bergeron et al., 1996). Tigecycline has in vitro activity against drug-resistant phenotypes including vancomycin-resistant enterococci (VRE), penicillin-resistant Streptococcus pneumoniae (PRSP), MSSA and MRSA

Altabax:

Altabax is a new antibiotic ointment. A new class of antibiotic, it is a semisynthetic derivative of the compound pleuromutilin, which comes through fermentation from Clitopilus passecherianus. Altabax works by selectively inhibiting bacterial protein synthesis.

Indicated for treatment of impetigo (superficial bacterial infections), Altabax is applied twice daily with or without bandaging.

Clinical studies demonstrated an 85 percent or more success rate, compared to 50 percent placebo success rate. Systemic absorption of Altabax is low, so drug interactions are not a concern.

When My son got MRSA his Primary put him on Altabax saying that it was much better than Mupirocin and left MRSA outbreaks no where to hide. It's downside is it cannot be used in the nose, a favorite hiding place for MRSA.
She was right it seems to heal open sores/boils in half the time and so far my son has not had another outbreak after 6 months.

ALTABAX is not intended for ingestion or for oral, intranasal, ophthalmic, or intravaginal use. ALTABAX has not been evaluated for use on mucosal surfaces.

Prescribing ALTABAX in the absence of a proven or strongly suspected bacterial infection is unlikely to provide benefit to the patient and increases the risk of the development of drug-resistant bacteria.

And if you do choose to go this route, I would also be sure to follow your course with a good, lengthy probiotics regimen...

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