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Report: Linezolid, rifampin used to treat two cases of MRSA preseptal cellulitis
Ophthal Plast Reconstr Surg. 2009;25(3):227-228.
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Linezolid and rifampin effectively managed two cases of preseptal cellulitis due to methicillin-resistant Staphylococcus aureus that did not respond to a full course of vancomycin therapy, according to a report.
This is the first known report of rifampin and linezolid to treat MRSA preseptal cellulitis that was recalcitrant to intravenous vancomycin, the report said. Both patients received incision and drainage of their abscess, followed by vancomycin, the current preferred treatment for MRSA-induced cellulitis. Testing showed the MRSA to be susceptible to vancomycin in both cases.
The disconnect between in vitro susceptibility and clinical utility may have been due to the pathogen's "putatively escalating minimal inhibitory concentration and its failure to reach effective therapeutic concentrations in affected cutaneous tissue (equivalent to reducing the area under the drug concentration-time curve)," the authors said.
Linezolid has proven effective in treating refractory MRSA infections in other clinical settings, and rifampin is known to have high penetration and, thus, high bioavailability.
"Rifampin is also one of the rare antibiotics with penetrance of and bactericidal qualities within the phagocytes in which MRSA may survive," the authors said.