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MRSA Treatment
Jun 8, 2005

Hi Doc,

I know this question is probably outside the realm of this forum, [I'd love to see a Complications or Management of HIV Infection forum here) but I thought maybe I'd ask anyway.

I've had recurring staphylococal infections for the past year - 4 this year, each MRSA. Each has been an abscess, 3 on the back of legs, 1 on the back near shoulder blade (this was the worst one). Each time I have taken large quantities of Bactrim DS after a culture indicated susceptibility to the drug. Each was also lanced and drained. I had one other start to pop up but I hibiclensed the hell out of it until it resolved on its own for the most part. The treatment for the most recent one seems to have taken away the remaining blemish that was under the skin.

I've also done the nasal Bactroban on 2 occasions and routinely have monitoring done with skin swabs when I have my normal labs done. Additionally I shower daily with hibiclens.

I'm currently completing treatment for the latest infection. I did 10 days initial Bactrim DS qid, then upped it to 6 a day for another 8 days. To "eradicate" the infection, my doctor has me taking 2 Bactrim DS daily for an additional 10 days plus Rifabutin 150mg on Monday-Wednesday-Friday-Sunday-Tuesday (5 total doses) plus another 10 day round of nasal Bactroban.

I've looked online for any liturature to support this course of treatment and wondered if you have heard of anyone else doing this before?

I am undetectable, 400 CD4, 21% CD4 and am taking the following medications daily: Truvada, Reyataz/r, Valtrex, Allegra, Marinol.

Just curious if you have heard of this being tried before and thought it might be of interest to some of the other readers experiencing MRSA.

Response from Dr. Pierone

Hello and thanks for posting. MRSA skin infections are commonly reported as a complication of HIV infection, and may be recurrent as in your situation.

I am not aware of any published studies on recurrent MRSA skin infections, but I can share my approach to this problem. First, look at the sensitivity pattern of the bacteria to see which antibiotics may be potentially useful. MRSA isolates from different regions may have quite different very different resistance patterns. Then I select an oral antibiotic - which in my part of Florida would typically be Bactrim (Septra, trimethoprim-sulfa), doxycycline, or clindamycin (Cleocin). Then, treat for a total of 3 months (again, this is for recurrent infections, not first time). This is combined with nasal bactroban for the first 10 days. For this prolonged approach, the doses of these antibiotics are lower than for treatment of the acute infection. This generally works, but not always.

If this "monotherapy" approach does not work and the infection comes back, after rechecking for a change in antibiotic resistance, I would retreat with combination therapy Rifabutin + one of the above antibiotics. Hope this helps and good luck.



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