From the Guidelines
Antibiotics that effectively cover gram-positive rods include vancomycin, linezolid, daptomycin, and various beta-lactams such as penicillins, cephalosporins, and carbapenems, with vancomycin being a commonly used option at a dose of 15-20 mg/kg IV every 8-12 hours, as recommended by the most recent guidelines 1.
Key Considerations
- The choice of antibiotic should be based on the specific organism, infection severity, and location, as well as local resistance patterns.
- Vancomycin is often used for empiric coverage of gram-positive rod infections, with target trough levels of 15-20 μg/mL for serious infections.
- Linezolid can be administered at 600 mg IV or orally every 12 hours, and is effective against MRSA and other gram-positive organisms.
- Other antibiotics, such as daptomycin, ceftaroline, and tedizolid, may also be effective against gram-positive rods, and should be considered based on the specific clinical scenario and local resistance patterns, as recommended by recent studies 1.
Specific Organisms
- For Listeria monocytogenes, ampicillin (2 g IV every 4 hours) is the preferred treatment, often combined with gentamicin for synergy in severe cases.
- Clostridium infections typically respond to metronidazole (500 mg IV or orally every 8 hours) or vancomycin (125-500 mg orally every 6 hours for C. difficile).
Treatment Duration
- Treatment duration generally ranges from 7-14 days depending on infection severity and location.
Important Notes
- The effectiveness of these antibiotics stems from their mechanisms of action targeting the bacterial cell wall, protein synthesis, or other essential bacterial functions that differ from human cells.
- It is essential to consider the specific organism and local resistance patterns when selecting an antibiotic for gram-positive rod infections, as recommended by the most recent guidelines 1.
From the FDA Drug Label
Gram-positive bacteria Enterococcus faecalis (vancomycin-susceptible isolates) Staphylococcus aureus (methicillin-susceptible and -resistant isolates) Streptococcus agalactiae Streptococcus anginosus group (includes S anginosus, S. intermedius, and S constellatus) Streptococcus pneumoniae (penicillin-susceptible isolates) Streptococcus pyogenes Gram-positive bacteria Enterococcus avium Enterococcus casseliflavus Enterococcus faecalis (vancomycin-resistant isolates) Enterococcus faecium (vancomycin-susceptible and -resistant isolates) Enterococcus gallinarum Listeria monocytogenes Staphylococcus epidermidis (methicillin-susceptible and -resistant isolates) Staphylococcus haemolyticus
The antibiotics that cover Gram-positive rods are:
- Tigecycline 2 which has been shown to be active against Listeria monocytogenes, a Gram-positive rod.
- Daptomycin 3 does not have direct information about its effectiveness against Gram-positive rods in the provided label.
From the Research
Antibiotics for Gram-Positive Rods
- The following antibiotics have been shown to be effective against gram-positive rods:
- These antibiotics have been tested against a variety of gram-positive bacteria, including:
- The effectiveness of these antibiotics can vary depending on the specific organism and the method of administration 6
Spectrum of Activity
- Linezolid has been shown to have a broad spectrum of activity against gram-positive bacteria, including MRSA, VRE, and VISA 4, 5
- Daptomycin has been shown to have a broad spectrum of activity against gram-positive bacteria, including vancomycin-resistant strains 7, 8
- Vancomycin has been shown to be effective against a variety of gram-positive bacteria, but its effectiveness can be limited by resistance 6, 8