What antibiotics are used for Methicillin-resistant Staphylococcus aureus (MRSA) coverage?

From the Guidelines

For MRSA coverage, linezolid and tedizolid are considered first-line oral antibiotics, while daptomycin and vancomycin are recommended for intravenous use, as suggested by the most recent guidelines 1. The choice of antibiotic depends on the severity of the infection, patient factors, and local resistance patterns.

• Oral antibiotics for MRSA coverage include:
  • Linezolid (600 mg twice daily)
  • Tedizolid (200 mg daily)
  • Trimethoprim-sulfamethoxazole (1-2 double-strength tablets twice daily)
  • Clindamycin (600 mg three times daily)
• Intravenous antibiotics for MRSA coverage include:
  • Daptomycin (10 mg/kg once daily)
  • Vancomycin (15-20 mg/kg every 8-12 hours)
  • Linezolid (600 mg twice daily)
  • Ceftaroline (600 mg every 12 hours) Treatment duration typically ranges from 7-14 days, depending on infection severity and clinical response, as recommended by the guidelines 1. When using vancomycin, regular monitoring of kidney function and drug levels is essential, while for daptomycin, weekly CPK monitoring is recommended to detect potential muscle toxicity, as suggested by previous studies 1. MRSA infections require aggressive treatment due to the organism's resistance to beta-lactam antibiotics, including all penicillins and cephalosporins (except ceftaroline), highlighting the importance of appropriate antibiotic selection and monitoring 1.

From the FDA Drug Label

The cure rates by pathogen for microbiologically evaluable patients are presented in Table 18. Table 18 Cure Rates at the Test-of-Cure Visit for Microbiologically Evaluable Adult Patients with Complicated Skin and Skin Structure Infections Pathogen Cured ZYVOX n/N (%) Oxacillin/Dicloxacillin n/N (%) Methicillin-resistant S aureus 2/3 (67) 0/0 (-)

A separate study provided additional experience with the use of ZYVOX in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections. The cure rates in microbiologically evaluable patients with MRSA skin and skin structure infection were 26/33 (79%) for linezolid-treated patients and 24/33 (73%) for vancomycin-treated patients

Table 19 Cure Rates at the Test-of-Cure Visit for Microbiologically Evaluable Adult Patients with Diabetic Foot Infections Pathogen Cured ZYVOX n/N (%) Comparator n/N (%) Methicillin-resistant S aureus 12/17 (71) 2/3 (67)

Antibiotics for MRSA coverage include:

• Linezolid (ZYVOX) with a cure rate of 79% in MRSA skin and skin structure infection 2
• Vancomycin with a cure rate of 73% in MRSA skin and skin structure infection 2
• Daptomycin for injection with a success rate of 44% in MRSA bacteremia/endocarditis, and 12.6% difference compared to vancomycin 3

It is essential to note that the choice of antibiotic should be based on the specific clinical scenario, including the severity of the infection, the presence of any underlying medical conditions, and the susceptibility of the MRSA isolate to different antibiotics.

From the Research

Antibiotics for MRSA Coverage

• Vancomycin remains an acceptable treatment option for MRSA, but its use is limited by concerns of nephrotoxicity and target attainment 4, 5.
• Linezolid is a potential first-line drug against MRSA bacteremia, with comparable effectiveness and safety to vancomycin, teicoplanin, or daptomycin 6.
• Linezolid may be a preferred antibiotic for the treatment of MRSA-caused complicated skin and soft tissue infections (SSTIs), showing superiority in clinical and microbiological success without difference regarding safety 7.
• Daptomycin is currently the only antibiotic to have shown noninferiority to vancomycin in the treatment of MRSA bacteremia 4.
• Ceftaroline is a broad-spectrum cephalosporin with activity against MRSA, and is non-inferior to vancomycin in the treatment of SSTIs 8.
• Tedizolid is another option for the treatment of MRSA-caused SSTIs, with comparable efficacy and safety to linezolid, vancomycin, and daptomycin 7.

Treatment Options

• Vancomycin: acceptable treatment option, but limited by nephrotoxicity and target attainment 4, 5.
• Linezolid: potential first-line drug against MRSA bacteremia, and preferred antibiotic for MRSA-caused SSTIs 6, 7.
• Daptomycin: noninferior to vancomycin in the treatment of MRSA bacteremia 4.
• Ceftaroline: non-inferior to vancomycin in the treatment of SSTIs 8.
• Tedizolid: comparable efficacy and safety to linezolid, vancomycin, and daptomycin for MRSA-caused SSTIs 7.

Considerations

• Nephrotoxicity and target attainment are concerns with vancomycin use 4, 5.
• Linezolid and tedizolid may be preferred options for MRSA-caused SSTIs due to their efficacy and safety profiles 6, 7.
• Daptomycin and ceftaroline are alternative options for the treatment of MRSA infections, but their use should be guided by clinical experience and resistance patterns 4, 8.