Trimethoprim/Sulfamethoxazole for Treatment of Severe Staphylococcus aureus Infections

OBJECTIVE: To evaluate the role of trimethoprim/sulfamethoxazole (TMP/SMX) as an alternative to vancomycin for the treatment of severe Staphylococcus aureus infections. DATA SOURCES: Clinical literature was accessed through MEDLINE (1966-February 2003) and EMBASE (1980-February 2003). Key search terms included trimethoprim/sulfamethoxazole combination and Staphylococcus aureus. DATA SYNTHESIS: An evaluation of case reports, case series, and clinical studies focusing on the use of TMP/SMX for treatment of severe S. aureus infections was conducted. The majority of the reports indicate that TMP/SMX may be effective for the treatment of infections due to low bacterial burdens of susceptible strains of S. aureus. CONCLUSIONS: In select infections, TMP/SMX may be a useful alternative to vancomycin for treatment of severe S. aureus infections. Additional randomized studies should be conducted comparing this agent with vancomycin and linezolid.