Antibiotic management of methicillin-resistant Staphylococcus aureus--associated acute pulmonary exacerbations in cystic fibrosis

Ann Pharmacother. 2015 Apr;49(4):458-68. doi: 10.1177/1060028014567526. Epub 2015 Jan 12.


Objective: To review the treatment of methicillin-resistant Staphylococcus aureus (MRSA)-associated acute pulmonary exacerbations (APEs) in cystic fibrosis (CF).

Data sources: A search of PubMed, MEDLINE, Cochrane Library and databases through November 2014 was conducted using the search terms Staphylococcus aureus, methicillin-resistant Staphylococcus aureus, pulmonary exacerbations, and cystic fibrosis.

Study selection and data extraction: All English-language research articles, case reports, and case series were evaluated. A total of 185 articles were identified related to MRSA and CF; 30 articles that studied treatments of MRSA APE in CF were included.

Data synthesis: The persistent presence of MRSA in the respiratory tract of patients with CF has been associated with higher morbidity and an increased risk of death. Limited clinical data exist supporting the efficacy of any specific antimicrobial currently available for the treatment of APE secondary to MRSA.

Conclusions: Data extrapolated from other populations suggest that vancomycin and linezolid are appropriate first-line treatment options for the treatment of APE secondary to MRSA. Second-line options include doxycycline or minocycline and trimethoprim/sulfamethoxazole, each of which may be useful in patients coinfected with other respiratory pathogens, for which they may provide overlapping coverage. Ceftaroline and ceftobiprole are newer antibiotics that appear to have a potential role in the treatment of APE in CF, but the latter is not currently available to the US market. Although potentially useful, clindamycin is limited by high rates of resistance, telavancin is limited by its toxicity profile, and tigecycline is limited by a lack of demonstrated efficacy for infections that are similar to that seen in the CF population. Studies investigating the clinical utility of the above-cited antibiotics for APE in CF secondary to MRSA are desperately needed to broaden the treatment armamentarium for this medical condition.

Keywords: anti-infective agents; cystic fibrosis; infection; methicillin-resistant Staphylococcus aureus.

Publication types

  • Review

MeSH terms

  • Acetamides / therapeutic use
  • Anti-Bacterial Agents / therapeutic use*
  • Cystic Fibrosis / drug therapy*
  • Cystic Fibrosis / microbiology
  • Humans
  • Linezolid
  • Methicillin Resistance / drug effects
  • Methicillin-Resistant Staphylococcus aureus / drug effects
  • Methicillin-Resistant Staphylococcus aureus / isolation & purification
  • Oxazolidinones / therapeutic use
  • Staphylococcal Infections / drug therapy*
  • Vancomycin / therapeutic use


  • Acetamides
  • Anti-Bacterial Agents
  • Oxazolidinones
  • Vancomycin
  • Linezolid