Clinical scenario | Antimicrobial regimens | |
Our preferred regimen | Alternate regimen(s) | |
Life-threatening infection suspected to be caused by S. aureus (health care- or community-associated) | ||
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Nonlife-threatening, nonendovascular infection (eg, pneumonia, septic arthritis, osteomyelitis) without signs of sepsis suspected to be caused by S. aureus | ||
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CNS: central nervous system; IV: intravenous; MRSA: methicillin-resistant S. aureus; AUC: area under the curve.
* Alternative dosing is suggested for clinicians/institutions who follow AUC-guided therapeutic monitoring for vancomycin for serious MRSA infections as suggested by consensus guidelines[5]; this strategy requires input from a clinical pharmacist, who will provide recommendations for initial dosing. Refer to UpToDate content on invasive staphylococcal infections in children for details of trough-guided and AUC-guided vancomycin dosing.
¶ For suspected MRSA pneumonia complicating influenza, addition of a second anti-MRSA agent (eg, clindamycin, ceftaroline, linezolid) within the first 24 hours of admission may be associated with decreased mortality. Refer to UpToDate content on treatment of invasive S. aureus infections in children for details.
Δ Experience with these agents in children is limited. Consultation with an expert in infectious diseases may be warranted.
◊ Daptomycin should not be used in children with concomitant pulmonary involvement. Daptomycin is active in vitro against multidrug-resistant gram-positive organisms, including S. aureus, but is not well studied in children. It is approved by the US Food and Drug Administration for the treatment of complicated skin and skin-structure infections in patients ≥1 year of age, the treatment of S. aureus bacteremia in children 1 through 17 years of age, and the treatment of S. aureus bacteremia (including right-sided endocarditis) in patients ≥18 years of age. Dosing for other indications is not well established.
§ Risk factors for health care-associated infection include personal history of or frequent contact with an individual with a history of hospitalization, surgery, dialysis, or residence in a long-term care facility within the previous year, frequent contact with the health care environment, presence of an invasive device (eg, intravascular catheter or tracheal tube), and history of MRSA infection or colonization.
¥ Information regarding local susceptibility patterns can be obtained from local public health officials or hospital laboratories. We provide coverage for MRSA when >10% of community isolates are MRSA; other experts may use a different threshold.
‡ Information regarding local susceptibility patterns can be obtained from local public health officials or hospital laboratories. The threshold prevalence of clindamycin-resistant MRSA for choosing vancomycin varies from center to center, usually ranging from 10 to 25%, in an effort to balance the benefit of definitive therapy for the patient with the risk of increasing vancomycin resistance in the community. Additional considerations in the decision to choose vancomycin include the prevalence of MRSA in the community, the severity of illness, and the turn-around time for susceptibilities.Do you want to add Medilib to your home screen?