From the Research
Gram-positive rods should be treated with vancomycin (15-20 mg/kg IV every 8-12 hours) as the first-line empiric therapy, considering the high rates of drug resistance among important pathogens, as suggested by the most recent study 1. When treating infections caused by gram-positive rods, it is essential to consider the specific pathogen and its susceptibility pattern. Common clinically significant gram-positive rods include Bacillus species, Clostridium species, Listeria monocytogenes, Corynebacterium diphtheriae, and Lactobacillus species.
- For empiric coverage of gram-positive rods, options include:
- Vancomycin (15-20 mg/kg IV every 8-12 hours)
- Ampicillin (1-2g IV every 4-6 hours)
- Clindamycin (600-900mg IV every 8 hours)
- Specific pathogens may require targeted therapy; for example:
- Listeria infections typically respond to ampicillin plus gentamicin
- Clostridium difficile infections require metronidazole or oral vancomycin, as supported by 1 and 2 Proper identification through culture and susceptibility testing is essential for definitive treatment. The cell wall structure of gram-positive bacteria, which contains thick peptidoglycan layers and teichoic acids, explains their gram-staining properties and influences their susceptibility to certain antibiotics like vancomycin, which targets cell wall synthesis 3.