Severe pneumonia caused by methicillin-resistant Staphylococcus aureus (MRSA) represents a major therapeutic challenge due to the high risk of clinical failure and the limited efficacy of conventional antibiotics in critically ill patients. We report the case of a 65-year-old woman with severe MRSA pneumonia, rapidly progressing to acute respiratory distress syndrome (ARDS) and apparently refractory to Linezolid and Ceftriaxone. Given the critical clinical condition, poor prognosis, and lack of alternative therapeutic options, off-label treatment with Oritavancin (Tenkasi®) was initiated at a dose of 1,200 mg IV infused over three hours. Within 48 hours after administration, a marked improvement in gas exchange was observed, allowing extubation and progressive clinical recovery. Oritavancin is a long-acting lipoglycopeptide approved for Gram-positive skin and soft tissue infections, but it demonstrates effective anti-MRSA activity in non-cutaneous sites as well. This case highlights its potential role as rescue therapy in selected settings such as respiratory infections caused by resistant pathogens refractory to standard therapy. In critical cases with failure of standard therapeutic options, Oritavancin may represent an effective and well-tolerated off-label option for the treatment of MRSA pneumonia refractory to conventional therapy, following multidisciplinary evaluation and informed consent.
Virzì et al. (Sun,) studied this question.