Trimethoprim-sulfamethoxazole versus vancomycin for severe infections caused by meticillin resistant Staphylococcus aureus: randomised controlled trial.
Trimethoprim-sulfamethoxazole versus vancomycin for severe infections caused by meticillin resistant Staphylococcus aureus: randomised controlled trial.
2015年に報告された、イスラエルのRCT
重症MRSA感染患者に対する、ST vs VCM 非劣勢試験
とても興味深いですね。
P : Adults with severe infections caused by MRSA susceptible to trimethoprim-sulfamethoxazole and vancomycin.
E : Trimethoprim-sulfamethoxazole 320 mg/1600 mg twice daily
C : vancomycin 1 g twice daily
minimum of seven days and then by indication.
O : No significant difference in treatment failure was seen for trimethoprim-sulfamethoxazole (51/135, 38%) versus vancomycin (32/117, 27%)-risk ratio 1.38 (95% confidence interval 0.96 to 1.99).
For patients with bacteraemia, the risk ratio was 1.40 (0.91 to 2.16). In a multivariable logistic regression analysis, trimethoprim-sulfamethoxazole was significantly associated with treatment failure (adjusted odds ratio 2.00, 1.09 to 3.65).
The 30 day mortality rate was 32/252 (13%), with no significant difference between arms. Among patients with bacteraemia, 14/41 (34%) treated with trimethoprim-sulfamethoxazole and 9/50 (18%) with vancomycin died (risk ratio 1.90, 0.92 to 3.93).
T : Parallel, open label, randomised controlled trial. acute care hospitals in Israel.
"High dose trimethoprim-sulfamethoxazole did not achieve non-inferiority to vancomycin in the treatment of severe MRSA infections. The difference was particularly marked for patients with bacteraemia. "
著者Paul M さんは、抗菌薬コンビネーション研究の有名人
https://www.ncbi.nlm.nih.gov/pubmed/?term=Paul%20M%5BAuthor%5D&cauthor=true&cauthor_uid=25977146
What this study adds
- In a randomised controlled trial including 252 inpatients, trimethoprim-sulfamethoxazole did not achieve non-inferiority to vancomycin in the treatment of severe MRSA infections
- The difference was particularly marked for patients with bacteraemia
- Adverse events rates were similar for trimethoprim-sulfamethoxazole and vancomycin