Trial reportBMJ (Clinical research ed.)2015
Trimethoprim-sulfamethoxazole versus vancomycin for severe infections caused by meticillin resistant Staphylococcus aureus: randomised controlled trial.
Trial report in BMJ (Clinical research ed.), 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00427076 (Treatment With Cotrimoxazole vs. Vancomycin for Infections Caused by Methicillin-resistant Staphylococcus Aureus), which is not on this map. Cited by 50 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Treatment With Cotrimoxazole vs. Vancomycin for Infections Caused by Methicillin-resistant Staphylococcus Aureus: Randomized Controlled Trial
Who cites it
50 citing papers in PubMed, 3 syntheses or guidelines pooled it, 151 citations in OpenAlex.
- The effect of combining antibiotics on resistance: A systematic review and meta-analysis.eLife · 2024Pooled it
- Oral Is the New IV. Challenging Decades of Blood and Bone Infection Dogma: A Systematic Review.The American journal of medicine · 2022Pooled it
- Vancomycin, Daptomycin, Antistaphylococcal β-Lactam, and Trimethoprim-Sulfamethoxazole Monotherapy and Combination Therapy in the Management of Methicillin-ResistantFrontiers in pharmacology · 2022Pooled it
- External validity of a randomised controlled trial on the treatment of severe infections caused by MRSA.BMJ open · 2015Trial
- The safety profile of trimethoprim-sulfamethoxazole regarding concomitant other drugs: a comparative analysis of adverse effects in a tertiary level adult intensive care unit.BMC infectious diseases · 2025Observational
- Review
- Review
- Early Oral Antibiotic Switch in Staphylococcus aureus Bacteraemia: The Staphylococcus aureus Network Adaptive Platform (SNAP) Trial Early Oral Switch Protocol.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2024Article
- The effect of combining antibiotics on resistance: A systematic review and meta-analysis.medRxiv : the preprint server for health sciences · 2024Article
- Impact of Vancomycin trough levels monitoring on uncomplicated methilcillin-resistant Staphylococcus aureus bacteremia in chronic kidney disease on hemodialysis, retrospective cohort.BMC infectious diseases · 2024Article
- Combination of Antistaphylococcal β-Lactam With Standard Therapy Compared to Standard Therapy Alone for the Treatment of Methicillin-ResistantOpen forum infectious diseases · 2024Article
- Article
- Oral Antibiotics for Bacteremia and Infective Endocarditis: Current Evidence and Future Perspectives.Microorganisms · 2023Review
- Contemporary Management of Staphylococcus aureus Bacteremia-Controversies in Clinical Practice.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2023Review
- Optimizing Dynamic Antibiotic Treatment Strategies against Invasive Methicillin-ResistantProceedings of machine learning research · 2023Article
- Uncomplicated Streptococcal Bacteremia: The Era of Oral Antibiotic Step-down Therapy?International journal of antimicrobial agents · 2023Article
- Persistent Methicillin-ResistantAntibiotics (Basel, Switzerland) · 2023Review
- Molecular Basis of Non-β-Lactam Antibiotics Resistance inAntibiotics (Basel, Switzerland) · 2022Review
- Current clinical practice in antibiotic treatment of Staphylococcus aureus bacteraemia: results from a survey in five European countries.The Journal of antimicrobial chemotherapy · 2022Article
- Investigational agents for the treatment of methicillin-resistantExpert opinion on investigational drugs · 2022Article
Corrections and comments
- Commented on by
Authors and funding
10 authors at 5 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo show non-inferiority of trimethoprim-sulfamethoxazole compared with vancomycin for the treatment of severe infections due to meticillin resistant Staphylococcus aureus (MRSA).
designParallel, open label, randomised controlled trial.
settingFour acute care hospitals in Israel.
participantsAdults with severe infections caused by MRSA susceptible to trimethoprim-sulfamethoxazole and vancomycin. Patients with left sided endocarditis, meningitis, chronic haemodialysis, and prolonged neutropenia were excluded.
interventionsTrimethoprim-sulfamethoxazole 320 mg/1600 mg twice daily versus vancomycin 1 g twice daily for a minimum of seven days and then by indication.
main outcome measuresThe primary efficacy outcome was treatment failure assessed at day 7, consisting of death, persistence of haemodynamic instability or fever, stable or worsening Sequential Organ Failure Assessment score, and persistence of bacteraemia. The primary safety outcome was all cause mortality at day 30. Non-inferiority was defined by a difference of less than 15% for treatment failure.
results252 patients were included in the trial, of whom 91 (36%) had bacteraemia. No significant difference in treatment failure was seen for trimethoprim-sulfamethoxazole (51/135, 38%) versus vancomycin (32/117, 27%)-risk ratio 1.38 (95% confidence interval 0.96 to 1.99). However, trimethoprim-sulfamethoxazole did not meet the non-inferiority criterion-absolute difference 10.4% (95% confidence interval -1.2% to 21.5%). For patients with bacteraemia, the risk ratio was 1.40 (0.91 to 2.16). In a multivariable logistic regression analysis, trimethoprim-sulfamethoxazole was significantly associated with treatment failure (adjusted odds ratio 2.00, 1.09 to 3.65). The 30 day mortality rate was 32/252 (13%), with no significant difference between arms. Among patients with bacteraemia, 14/41 (34%) treated with trimethoprim-sulfamethoxazole and 9/50 (18%) with vancomycin died (risk ratio 1.90, 0.92 to 3.93).
conclusionsHigh dose trimethoprim-sulfamethoxazole did not achieve non-inferiority to vancomycin in the treatment of severe MRSA infections. The difference was particularly marked for patients with bacteraemia. Trial registration Clinical trials NCT00427076.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.