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October 27, 2008

Adjunctive Use of Rifampin for the Treatment of Staphylococcus aureus Infections: A Systematic Review of the Literature

Author Affiliations

Author Affiliations: Division of Infectious Diseases (Drs Perlroth, Bayer, and Miller) and Los Angeles Biomedical Research Institute (Ms Tan and Dr Miller), Department of Medicine, Harbor-UCLA Medical Center, Torrance, California, St Mary Medical Center, Long Beach (Dr Kuo), and Division of Infectious Diseases, David Geffen School of Medicine at the University of California, Los Angeles (Drs Bayer and Miller). Dr Kuo is now with Division of Infectious Diseases, Department of Medicine, University of California, Irvine.

Arch Intern Med. 2008;168(8):805-819. doi:10.1001/archinte.168.8.805

Background  Staphylococcus aureus causes severe life-threatening infections and has become increasingly common, particularly methicillin-resistant strains. Rifampin is often used as adjunctive therapy to treat S aureus infections, but there have been no systematic investigations examining the usefulness of such an approach.

Methods  A systematic review of the literature to identify in vitro, animal, and human investigations that compared single antibiotics alone and in combination with rifampin therapy against S aureus.

Results  The methods of in vitro studies varied substantially among investigations. The effect of rifampin therapy was often inconsistent, it did not necessarily correlate with in vivo investigations, and findings seemed heavily dependent on the method used. In addition, the quality of data reporting in these investigations was often suboptimal. Animal studies tended to show a microbiologic benefit of adjunctive rifampin use, particularly in osteomyelitis and infected foreign body infection models; however, many studies failed to show a benefit of adjunctive therapy. Few human studies have addressed the role of adjunctive rifampin therapy. Adjunctive therapy seems most promising for the treatment of osteomyelitis and prosthetic device–related infections, although studies were typically underpowered and benefits were not always seen.

Conclusions  In vitro results of interactions between rifampin and other antibiotics are method dependent and often do not correlate with in vivo findings. Adjunctive rifampin use seems promising in the treatment of clinical hardware infections or osteomyelitis, but more definitive data are lacking. Given the increasing incidence of S aureus infections, further adequately powered investigations are needed.