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Fosfomycin plus imipenem effective for MRSA bacteremia, endocarditis
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SAN DIEGO — Fosfomycin in combination with imipenem was effective for treating MRSA bacteremia and endocarditis, representing a viable alternative to standard antibiotic treatments with waning clinical utility, according to the results of a small randomized clinical trial.
The findings were presented during a session at ICAAC 2015 focused on the repurposing of existing drugs for new treatments.
Juan Pericas
“There is an urgent need for alternative therapies to [vancomycin (VAN)] and Cubicin (daptomycin, Cubist Pharmaceuticals) to treat invasive MRSA infections,” Juan M. Pericas, MD, from the Hospital Clinic of Barcelona, Spain, and colleagues said, noting that the combination of fosfomycin (FOS) and imipenem (IMI) was proven in a previous study to be a safe and effective rescue therapy for complicated bacteremia and endocarditis involving MRSA strains.
Pericas and colleagues conducted an open-label, randomized clinical trial across 10 health care centers to evaluate the safety and efficacy of the combination of FOS and IMI (FOS+IMI) for the initial treatment of patients with complicated MRSA bacteremia or endocarditis, compared with VAN as standard treatment.
Of the 201 cases evaluated, 15 patients were included in the analysis between 2009 and 2014. Seven patients had complicated bacteremia, and eight had endocarditis. Eight cases were randomly assigned to FOS+IMI and seven to VAN. One patient from the VAN arm and no patients from the FOS+IMI arm had persistent bacteremia.
Within 3 days, all patients in the FOS+IMI arm had negative blood cultures. The combination treatment was safe, according to the researchers, with only one patient having salt overload. In addition, the treatment prevented superinfection by multidrug-resistant bacteria compared with FOS (0% vs. 57%; P = .026). Pericas and colleagues said the curation rates were 50% for FOS+IMI, with one treatment discontinuation due to salt overload and three deaths, and 43% for VAN, with one case of persistent bacteremia, one treatment discontinuation due to renal toxicity, one relapse and one death.
The researchers acknowledged the limitations of such a small sample size, but emphasized that the FOS+IMI combination was a safe and effective treatment option for patients with complicated bacteremia or endocarditis stemming from MRSA infection. – by John Schoen
References:
Pericas JM, et al. Abstract B-057. Presented at: Interscience Conference on Antimicrobial Agents and Chemotherapy; Sept. 17-21, 2015; San Diego.
Del Rio A, et al. Clin Infect Dis. 2014;doi:10.1093/cid/ciu580.
Disclosure: Pericas reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.