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January 1985

Rifampin Resistance: Development During the Therapy of Methicillin-Resistant Staphylococcus aureus Infection

Author Affiliations

From the Infectious Disease Section, Medical Service (Dr Eng), and the Microbiology Section, Laboratory Service (Dr Smith), Veterans Administration Medical Center, East Orange, NJ; the Department of Medicine, Bayley Seton Hospital, Staten Island, NY (Dr Cherubin); and the Departments of Medicine (Drs Eng and Tillem) and Microbiology (Dr Smith), University of Medicine and Dentistry of New Jersey, Newark.

Arch Intern Med. 1985;145(1):146-148. doi:10.1001/archinte.1985.00360010188034

• The incidence of methicillin-resistant staphylococcal infections, for which vancomycin hydrochloride remains the only active cell-wall antibiotic therapy, is rising. Some physicians have been combining other antibiotics with vancomycin in hopes of obtaining a more effective regimen for the therapy of these infections. Rifampin has been advocated as a concurrent second antibiotic because of its extraordinary potent bactericidal activity for Staphylococcus aureus. When rifampin is used in combination with a cell-wall antibiotic, suppression of the development of rifampin resistance has been thought possible. We report a case of infection caused by a methicillin-resistant S aureus in which the rifampin resistance occurred during therapy with vancomycin and rifampin. The rifampin resistance was stable and was present after ten serial broth and agar passages. Physicians are cautioned against the indiscriminant or routine use of rifampin as a second antibiotic in combination with vancomycin for the therapy of infections caused by S aureus.

(Arch Intern Med 1985;145:146-148)