Vancomycin trough concentrations of 15 to 20 mcg per mL are recommended in patients with serious infections, such as bacteremia, infective endocarditis, osteomyelitis, meningitis, pneumonia, or severe skin and soft-tissue infections (e.g., necrotizing fasciitis) caused by MRSA. When doing empiric abx coverage, you want to think of covering the following as needed. The decision to use combination therapy should be individualized. Transesophageal echocardiography is preferred over transthoracic echocardiography. (I was prescribed twice a day) I've thrown up twice with it and have to try very hard to keep it down. In addition, in vitro susceptibility of MRSA … Infection from β-hemolytic streptococci does not usually require empiric therapy. For isolates with a vancomycin minimal inhibitory concentration greater than 2 mcg per mL (e.g., vancomycin-intermediate A search for and removal of other foci of infection, drainage, or surgical debridement is recommended. If the patient is stable without ongoing bacteremia or intravascular infection, clindamycin (10 to 13 mg per kg intravenously every six to eight hours for a total of 40 mg per kg per day) can be used as empiric therapy if the clindamycin resistance rate is low (e.g., less than 10 percent). Empiric coverage for community-associated MRSA is recommended in patients who do not respond to beta-lactam antibiotics, and also may be considered in those with systemic toxicity.Oral antibiotic options for treating skin and soft-tissue infections in patients with community-associated MRSA include clindamycin, trimethoprim/sulfamethoxazole (TMP/SMX; Bactrim, Septra), a tetracycline (doxycycline or minocycline [Minocin]), and linezolid (Zyvox). Includes dosages for Bacterial Infection, Urinary Tract Infection, Acne and … PMID: "Initial Antibiotic Choice in Uncomplicated Cellulitis", REBEL EM blog,
The in vitro activity of new and investigational agents against VISA and VRSA has recently been reviewed elsewhere . Doxycycline is a broad-spectrum tetracycline-class antibiotic used in the treatment of infections caused by bacteria and certain parasites. Doxycycline is a broad-spectrum tetracycline-class antibiotic used in the treatment of infections caused by bacteria and certain parasites. Some experts recommend higher dosages of daptomycin (8 to 10 mg per kg intravenously once per day). 14 December 2012. Patients should cover draining wounds with clean, dry bandages. Echocardiography is recommended for all adults with bacteremia. Strategies for decolonization include nasal decolonization with mupirocin twice per day for five to 10 days, or nasal decolonization with mupirocin twice per day for five to 10 days plus topical body decolonization with a skin antiseptic solution (e.g., chlorhexidine [Peridex]) for five to 14 days or dilute bleach baths. Rifampin is not recommended for use as a single agent or adjunctive therapy.For hospitalized patients with complicated skin and soft-tissue infections (i.e., deeper soft-tissue infections, surgical or traumatic wound infection, major abscesses, cellulitis, or infected ulcers and burns), empiric therapy for MRSA should be considered pending culture results, in addition to surgical debridement and broad-spectrum antibiotics. Clinical failure defined as no increase in erythema > 25%, fever, swelling or tenderness at 3-4 day follow up, no decrease in erythema, swelling or tenderness at 8-10 day follow up or anything more than minimal erythema, swelling or tenderness at 14-21 day follow up.Composite clinical cure rate (resolution of all symptoms and signs), surgical drainage procedures, changes in erythema size, presence of swelling/induration and tenderness, invasive infections, skin infections at the same or different site, hospitalizations, similar infections in household contacts, days missed from normal activities and days of analgesic usePerformed both per-protocol (n = 496) and intention-to-treat (n = 411) analysisDetermined to give 90% power to detect a 10% differenceFollow-up evaluations occurred in person or if unable, by telephonePerformed both per-protocol and intention-to-treat analysisPatients lost to follow up were considered treatment failure which would underestimate the results of this trial for clinical cureStudy powered to find 10% difference but smaller differences may still be clinically significantUS performed on every patient to eliminate abscess.