Rifampicin as monotherapy for infections caused by S. aureus: Considerations for not applying “breakpoints in brackets”

Sara E. Boyd; Mandy Wootton; Robin A. Howe; David M. Livermore; Alasdair P. MacGowan; Gunnar Kahlmeter

doi:10.1093/jac/dkaf392

Rifampicin as monotherapy for infections caused by S. aureus: Considerations for not applying “breakpoints in brackets”

Sara E. Boyd
, Mandy Wootton
, Robin A. Howe
, David M. Livermore
, Alasdair P. MacGowan
, Gunnar Kahlmeter

Research output: Contribution to journal › Short survey › peer-review

Abstract

EUCAST introduced 'breakpoints in brackets' to warn against the use of specified agents without additional therapeutic measures (EUCAST. Guidance document "EUCAST breakpoints in brackets". 2021. Available at: www.mic.eucast.org.). Rifampicin is rarely used as monotherapy for Staphylococcus aureus infections, yet its breakpoints remain unbracketed. Here, we explore whether this remains appropriate. Although frequent emergent resistance largely precludes rifampicin's use as monotherapy, this does not meet EUCAST's core criterion for bracketing-that an agent is inherently ineffective as monotherapy.

Original language	English
Pages (from-to)	3191–3193
Number of pages	3
Journal	Journal of Antimicrobial Chemotherapy
Volume	80
Issue number	12
Early online date	3 Nov 2025
DOIs	https://doi.org/10.1093/jac/dkaf392
Publication status	Published - 1 Dec 2025

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10.1093/jac/dkaf392Licence: CC BY

Rifampicin_Viewpoint_acceptedAccepted author manuscript, 39 KBLicence: CC BY

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title = "Rifampicin as monotherapy for infections caused by S. aureus: Considerations for not applying {\textquotedblleft}breakpoints in brackets{\textquotedblright}",

abstract = "EUCAST introduced 'breakpoints in brackets' to warn against the use of specified agents without additional therapeutic measures (EUCAST. Guidance document {"}EUCAST breakpoints in brackets{"}. 2021. Available at: www.mic.eucast.org.). Rifampicin is rarely used as monotherapy for Staphylococcus aureus infections, yet its breakpoints remain unbracketed. Here, we explore whether this remains appropriate. Although frequent emergent resistance largely precludes rifampicin's use as monotherapy, this does not meet EUCAST's core criterion for bracketing-that an agent is inherently ineffective as monotherapy.",

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TY - JOUR

T1 - Rifampicin as monotherapy for infections caused by S. aureus: Considerations for not applying “breakpoints in brackets”

AU - Boyd, Sara E.

AU - Wootton, Mandy

AU - Howe, Robin A.

AU - Livermore, David M.

AU - MacGowan, Alasdair P.

AU - Kahlmeter, Gunnar

PY - 2025/12/1

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N2 - EUCAST introduced 'breakpoints in brackets' to warn against the use of specified agents without additional therapeutic measures (EUCAST. Guidance document "EUCAST breakpoints in brackets". 2021. Available at: www.mic.eucast.org.). Rifampicin is rarely used as monotherapy for Staphylococcus aureus infections, yet its breakpoints remain unbracketed. Here, we explore whether this remains appropriate. Although frequent emergent resistance largely precludes rifampicin's use as monotherapy, this does not meet EUCAST's core criterion for bracketing-that an agent is inherently ineffective as monotherapy.

AB - EUCAST introduced 'breakpoints in brackets' to warn against the use of specified agents without additional therapeutic measures (EUCAST. Guidance document "EUCAST breakpoints in brackets". 2021. Available at: www.mic.eucast.org.). Rifampicin is rarely used as monotherapy for Staphylococcus aureus infections, yet its breakpoints remain unbracketed. Here, we explore whether this remains appropriate. Although frequent emergent resistance largely precludes rifampicin's use as monotherapy, this does not meet EUCAST's core criterion for bracketing-that an agent is inherently ineffective as monotherapy.

UR - https://www.scopus.com/pages/publications/105023549929

U2 - 10.1093/jac/dkaf392

DO - 10.1093/jac/dkaf392

M3 - Short survey

SN - 0305-7453

VL - 80

SP - 3191

EP - 3193

JO - Journal of Antimicrobial Chemotherapy

JF - Journal of Antimicrobial Chemotherapy

IS - 12

ER -

Rifampicin as monotherapy for infections caused by S. aureus: Considerations for not applying “breakpoints in brackets”

Abstract

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