Vancomycin rifampicin combination

Infections limited to soft tissue will require between 7 and 10 days of intravenous therapy followed by an additional 14 days of oral therapy (total duration 2-4 weeks). If MRSA is isolated, intravenous vancomycin must not be switched to oral vancomycin which has negligible absorption from the gastrointestinal tract. Oral agents may be selected from rifampicin, tetracyclines, fusidic acid or trimethoprim depending on sensitivity data and a combination of two agents is recommended. Oral linezolid monotherapy is an effective alternative. 

Relapses are similarly frequent after treatment with metronidazole and vancomycin (116). In 189 adult patients, a first relapse occurred in up to 24% and a second relapse in 46% (169). Relapse may be due to sporulation of C. difficile and not to the development of resistance. Relapses usually respond to further courses of the initial treatment. Some alternative treatments have been proposed for repeatedly relapsing cases, including the combination of vancomycin with rifampicin for 10 days (171). 

Prostatitis due to vancomycin-resistant enterococci has been reported in a 42-year-old liver transplant recipient (84). The organism. Enterococcus faecium, was resistant to vancomycin, ampicillin, ciprofloxacin, and doxycycline. Treatment with a combination of rifampicin and nitrofurantoin for 6 weeks resulted in a long-lasting cure. 

Rifampicin possesses significant bactericidal activity at very low concentrations against staphylococci. Unfortunately, resistant mutants may arise very rapidly, both in vitro and in vivo. It has thus been recommended that rifampicin should be combined with another antibiotic, e.g. vancomycin, in the treatment of staphylococcal infections. 

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