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1 February 2006

Volume 42, Number 3
Clinical Infectious Diseases 2006;42:394–400
© 2005 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2006/4203-0017$15.00
DOI: 10.1086/499365
ANTIMICROBIAL RESISTANCE INVITED ARTICLE

Dumb and Dumber—The Potential Waste of a Useful Antistaphylococcal Agent: Emerging Fusidic Acid Resistance in Staphylococcus aureus

Benjamin P. Howden1,2 and

M. Lindsay Grayson1,3,4

1Infectious Diseases Department, Austin Health, Heidelberg, and Departments of 2Microbiology and 3Epidemiology and Preventive Medicine, Monash University, and 4Department of Medicine, University of Melbourne, Melbourne, Australia

Fusidic acid has activity against a range of pathogens but has mainly been used to treat staphylococcal infections. Fusidic acid monotherapy, especially topical preparations, has been strongly associated with the emergence of fusidic acid resistance among both methicillin‐resistant Staphylococcus aureus (MRSA) and methicillin‐susceptible S. aureus. Key resistance determinants include mutations in the fusA gene, which encodes elongation factor G, and plasmid‐mediated resistance (i.e., acquisition of resistance gene fusB). Clonal outbreaks of fusidic acid–resistant S. aureus have been noted throughout the United Kingdom and Europe, such that the efficacy of fusidic acid is threatened. Fusidic acid in combination with other agents, such as rifampicin, has proven effective for difficult‐to‐treat MRSA infections and provides a convenient oral alternative to oxazolidinones. Ensuring that systemic fusidic acid is always used in combination and that the use of topical fusidic acid is either abolished or restricted will be vital if we are to prevent the loss of this potentially useful agent.

Received 19 August 2005; accepted 16 October 2005; electronically published 15 December 2005.

Reprints or correspondence: Prof. M. Lindsay Grayson, Infectious Diseases Dept., Austin Health, Studley Rd., Heidelberg, Victoria, 3084, Australia ().

George M. Eliopoulos, Section Editor

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