Introduction: Fusidic Acid Enters the United States

The emergence of infections due to communityassociated methicillin-resistant Staphylococcus aureus (MRSA) in the United States (and elsewhere in the world) during the past decade has brought the rather pedestrian spectrum of acute bacterial skin and skin structure infections (ABSSSIs) to a new level of concern [1]. Previously recommended oral antibiotics, such as oxacillin, cloxacillin, dicloxacillin, and cephalexin, have no useful activity against MRSA. Unless infection with these organisms can be excluded clinically, empirical coverage for MRSA is indicated in many areas of the United States where the prevalence of communityassociated MRSA exceeds 30%–50% [2]. Granted that many of the ABSSSIs caused by community-associated MRSA, such as small, uncomplicated abscesses, are relatively ‘‘benign’’ and may respond to surgical drainage alone, these organisms nonetheless are fully capable of causing severe disease including bacteremia with overwhelming sepsis, endocarditis, and metastatic abscesses in the setting of ABSSSI [3]. Given these facts, it is clear that there is a need for effective antimicrobial agents to treat ABSSSI, and such agents must include the 2 major organisms that cause this disease (S. aureus [including MRSA] and group A streptococci) in their spectrum. Except for linezolid, to our knowledge, there have been no definitive randomized trials for oral agents currently being used to treat ABSSSI in the United States. Thus, there is a real need for additional data and for the development of more effective oral agents for these infections, not only in the skin but elsewhere in the body as well. The growing importance of MRSA is reflected in the fact that the Infectious Diseases Society of America has just promulgated an extensive set of clinical practice guidelines for the treatment of MRSA infection in adults and children [4]. This comprehensive document reviews the major syndromes caused by MRSA and provides a set of logical therapeutic recommendations. The recommendations for oral therapy include clindamycin, trimethoprim-sulfamethoxazole, a tetracycline (doxycycline or minocycline), and linezolid. They also recommend that if coverage for both b-hemolytic streptococci and community-associated MRSA is desired, trimethoprim-sulfamethoxazole or one of the tetracyclines should be used in combination with a blactam, such as amoxicillin. Clindamycin or linezolid alone was also believed to be likely effective in this setting, despite the increasing rate of resistance to clindamycin. Notably, the use of rifampicin as a single agent or as adjunctive treatment for ABSSSI was not recommended. Conspicuously absent from this list of recommended antimicrobial agents is an antibiotic that has been widely used throughout the world but never licensed in the United States—namely, fusidic acid. The reasons for it not having been licensed in the United States are likely due to marketing considerations rather than efficacy, because it has been used very effectively for the treatment of staphylococcal infections in many other countries. In addition to demonstrating effectiveness for the management of infections due to S. aureus (including MRSA), the drug has also had an excellent safety record. One of the primary issues that has been of concern Correspondence: Robert C. Moellering Jr, MD, Beth Israel Deaconess Medical Center, Dept of Medicine, 110 Francis St, Suite 6A, Boston, MA 02215 (rmoeller@bidmc.harvard.edu). Clinical Infectious Diseases 2011;52(S7):S467–S468 The Author 2011. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com. 1058-4838/2011/52S7-0001$14.00 DOI: 10.1093/cid/cir171