• Oki Nugraha Putra Departement of Pharmaceutics, Study Program of Pharmacy, Faculty of Medicine, Hang Tuah University, Surabaya, Indonesia.
  • Iswinarno Doso Saputro Departement of Plastic Surgery and Reconstructive, Dr. Soetomo Hospital, Surabaya, Indonesia.
  • Ana Khusnul F Departement of Clinical Pharmacy, Study Program of Pharmacy, Faculty of Medicine, Hang Tuah University, Surabaya, Indonesia.


Objective: Thus, this case report assesses the efficacy combination of fosfomycin and amikacin in the management of MRSA infection in a burn patient.

Case Report: A 31-year-old male was transferred to the burn center for definitive treatment. Initially, the patient was treated with ceftazidime injection as empiric antibiotic one gram three times daily, but the patient became sepsis during the treatment. Blood specimen was taken and Methicilin Resistant Staphylococcus aureus (MRSA) was isolated from this culture. The patient was isolated and based on antibiotic susceptibility, the patient was started on fosfomycin 2 gram IV twice daily for first seven days, and after that fosfomycin was combined with amikacin IV 500 mg once daily. After administration of these antibiotics, a rapid clinical improvement was observed with the patient, leucocytosis did not occur and blood culture was negative. The patient completed a total of 14 days of fosfomycin and 8 days of amikacin therapy.

Conclusion: The synergistic combination of fosfomycin with amikacin, may be useful alternative treatment option for sepsis related Methicilin- Resistant Staphylococcus aureus (MRSA) in burn injury. Further research is also needed to clarify effectiveness of fosfomycin and amikacin to treat MRSA infection in burn patient.

Keywords: Methicilin-resistant Staphylococcus aureus, Scald burn, Sepsis, Fosfomycin, Amikacin.


1. Jeffres MN, Isakow W, Doherty JA, McKinnon PS, Ritchie DJ, Micek ST, et al. Predictors of mortality for methicillin-resistant Staphylococcus aureus health-care-associated pneumonia: Specific evaluation of vancomycin pharmacokinetic indices. Chest 2006;130:947-55.
2. Nakazawa H, Kikuchi Y, Honda T, Isago T, Nozaki M. Enhancement of antimicrobial effects of various antibiotics against methicillin-resistant Staphylococcus aureus (MRSA) by combination with fosfomycin. J Infect Chemother 2003;9:304-9.
3. Nikfar R, Shamsizadeh A, Ziaei Kajbaf T, Kamali Panah M, Khaghani S, Moghddam M, et al. Frequency of methicillin-resistant Staphylococcus aureus nasal carriage in healthy children. Iran J Microbiol 2015;7:67 71.
4. Susethira AR, Uma A, Prabhu N., Management of methicillin resistant Staphylococcus aureus infection of endogenous origin in an electrical burns patient-a case report. Br Microbiol Res J 2014;4:1138-41.
5. Yezli S, Li H. Antibiotic resistance amongst healthcare-associated pathogens in China. Int J Antimicrob Agents 2012;40:389-97.
6. Haque NZ, Zuniga LC, Peyrani P, Reyes K, Lamerato L, Moore CL, et al. Relationship of vancomycin minimum inhibitory concentration to mortality in patients with methicillin-resistant Staphylococcus aureus hospital-acquired, ventilator-associated, or health-care-associated pneumonia. Chest 2010;138:1356-62.
7. Sakoulas G, Moise-Broder PA, Schentag J, Forrest A, Moellering RC Jr. Eliopoulos GM, et al. Relationship of MIC and bactericidal activity to efficacy of vancomycin for treatment of methicillin-resistant Staphylococcus aureus bacteremia. J Clin Microbiol 2004;42:2398- 402.
8. Niida M, Yoshida T, Kohmoto A, Ogawa M, Hashimoto H, Deguchi K, et al. Studies on the combined effect of fosfomycin with sulbactam/ cefoperazone on methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa. Jpn J Antibiot 1994;47:1-0.
9. Misawa S, Tsuda S, Taniwaki M, Horiike S, Ariyama Y, Hirakawa K, et al. A combined consecutive therapy with fosfomycin and sulbactam/ cefoperazone for bacterial infections associated with hematological diseases. Jpn J Antibiot 1995;48:514-21.
10. Tenover FC. Mechanisms of antimicrobial resistance in bacteria. Am J Med 2006;119:S3-10.
11. Nakao M, Senda Y. An epidemiological investigation of hospital infections caused by MRSA and their prevention. Kawasaki J Med Welf. 2006;11:1-11.
12. Begier EM, Frenette K, Barrett NL, Mshar P, Petit S, Boxrud DJ, et al. A high-morbidity outbreak of methicillin-resistant Staphylococcus aureus among players on a college football team, facilitated by cosmetic body shaving and turf burns. Clin Infect Dis 2004;39:1446-53.
13. Seguin JC, Walker RD, Caron JP, Kloos WE, George CG, Hollis RJ, et al. Methicillin-resistant Staphylococcus aureus outbreak in a veterinary teaching hospital: Potential human-to-animal transmission. J Clin Microbiol 1999;37:1459-63.
14. Lee JH. Methicillin (Oxacillin)-resistant Staphylococcus aureus strains isolated from major food animals and their potential transmission to humans. Appl Environ Microbiol 2003;69:6489-94.
15. Severin JA, Lestari ES, Kuntaman K, Melles DC, Pastink M, Peeters JK, et al. Unusually high prevalence of panton-valentine leukocidin genes among methicillin-sensitive Staphylococcus aureus strains carried in the indonesian population. J Clin Microbiol 2008;46:1989-95.
16. Santosaningsih D, Santoso S, Budayanti NS, Kuntaman K, Lestari ES, Farida H, et al. Epidemiology of Staphylococcus aureus harboring the mecA or panton-valentine leukocidin genes in hospitals in java and bali, Indonesia. Am J Trop Med Hyg 2014;90:728-34.
17. Bagdonas R, Tamelis A, Rimdeika R. Stpahylococcus aureus infection in the surgery of burns. MEDICINA 2003;39:11.
18. Issler-Fisher AC, McKew G, Fisher OM, Harish V, Gottlieb V, Maitz PK. Risk factor for, and the effect of MRSA colonization on the clinical outcome of severly burn patients. Burns 2015;41:1212-20.
19. Conil JM, Georges B, Lavit M, Seguin T, Tack I, Samii K, et al. Pharmacokinetics of ceftazidime and cefepime in burn patients: The importance of age and creatinine clearance. Int J Clin Pharmacol Ther 2007;45:529-38.
20. Takahashi K, Kanno H. Synergistic activities of combination of beta lactams, fosfomycin, and tobramycin against Pseudomonas aeruginosa. Antimicrob Agents Chemother 1984;26:789-91.
21. Chin NX, Neu NM, Neu HC. Synergy of fosfomycin with beta-lactam antibiotics against staphylococci and Aerobic gram-negative bacilli. Drugs Exp Clin Res 1986;12:943-7.
22. Okazaki M, Suzuki K, Asano N, Araki K, Shukuya N, Egami T, et al. Effectiveness of fosfomycin combined with other antimicrobial agents against multidrugresistant Pseudomonas aeruginosa isolates using the efficacy time index assay. J Infect Chemother 2002;8:37-42.
23. Souli M, Galani I, Antoniadou A, Papadomichelakis E, Poulakou G, Panagea T, et al. An outbreak of infection due to beta-lactamase klebsiella pneumoniae carbapenemase 2-producing K. Pneumoniae in a greek university hospital: Molecular characterization, epidemiology, and outcomes. Clin Infect Dis 2010;50:364-73.
24. Michalopoulos A, Virtzili S, Rafailidis P, Chalevelakis G, Damala M, Falagas ME. Intravenous fosfomycin for the treatment of nosocomial infections due to carbapenem-resistant Klebsiella pneumoniae in critically ill patients: A prospective evaluation. Clin Microbiol Infect 2010;16:184-6.
25. Yamaguchi Y, Hanaki H, Yanagisawa C, Ikeda-Dantsuji Y, Hashimoto T, Yazaki H, et al. Characterization of beta-lactam antibiotic-induced vancomycin-resistant MRSA (BIVR) in a patient with septicemia during long-term vancomycin administration. J Infect Chemother 2009;15:274-8.
26. Weinbren MJ. Pharmacokinetics of antibiotics in burn patients. J Antimicrob Chemother 1999;44:319-27.
27. Loirat P, Rohan J, Baillet A, Beaufils F, David R, Chapman A, et al. Increased glomerular filtration rate in patients with major burns and its effect on the pharmacokinetics of tobramycin. N Engl J Med 1978;299:915-9.
28. Marik PE, Lipman J, Kolski S, Scribante J. A prospective randomized study comparing once- versus twice-daily amikacin dosing in critically ill adult and paediatric patients. J Antimicrob Chemother 1991;28:753 64.
29. Barza M, Ioannidis JP, Cappelleri JC, Lau J. Single or multiple daily doses of aminoglycosides: A meta-analysis. BMJ 1996;312:338-45.
30. Hoey LL, Tschida SJ, Rotschafer JC, Guay DRP, Vance-Bryan K. Wide variation in single, daily-dose aminoglycoside pharmacokinetics in patients with burn injuries. J Burn Care Rehabil 1997;18:116-24.
31. Zaske DE, Sawchuk RJ, Strate RG. The necessity of increased doses of amikacin in burn patients. Surgery 1978;84:603-8.
32. Beaucaire G, Leroy O, Beuscart C, Karp P, Chidiac C, Caillaux M, et al. Clinical and bacteriological efficacy, and practical aspects of amikacin given once daily for severe infections. J Antimicrob Chemother 1991;27 Suppl C:91-103.
33. Conil JM, Georges B, Berden A, Segonds C, Lavit M, Seguin T, et al. Increased amikacin dosage requirements in burn patients receiving a once-daily regime. Int J Antimicrob Agents 2006;28:226-30.
34. Akers KS, Cota JM, Frei CR, Chung KK, Mende K, Murray CK, et al. Once-daily amikacin dosing in burn patients treated with continuous venovenous hemofiltration. Antimicrob Agents Chemother 2011;55:4639-42.
35. Montgomery AB, Rhomberg P, Abuan T, Jones R. Synergistic effects for a combination of amikacin and fosfomycin aginst selected resistant gram-negative pathogens. Am J Respirat Crit Care Med 2013;2013:14 8.
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How to Cite
Putra, O. N., I. D. Saputro, and A. K. F. “TREATMENT OF METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS (MRSA) SEPSIS WITH COMBINATION OF FOSFOMYCIN AND AMIKACIN IN A PATIENT WITH SCALD-BURN INJURY”. Asian Journal of Pharmaceutical and Clinical Research, Vol. 11, no. 15, Oct. 2018, pp. 17-19, doi:10.22159/ajpcr.2018.v11s3.30018.
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