From the FDA Drug Label
- 2 Staphylococcus aureus Bloodstream Infections (Bacteremia) in Adult Patients, Including Those with Right-Sided Infective Endocarditis, Caused by Methicillin-Susceptible and Methicillin-Resistant Isolates Daptomycin for injection is indicated for the treatment of adult patients with Staphylococcus aureus bloodstream infections (bacteremia), including adult patients with right-sided infective endocarditis, caused by methicillin-susceptible and methicillin-resistant isolates.
5.9 Persisting or Relapsing S. aureus Bacteremia/Endocarditis Patients with persisting or relapsing S. aureus bacteremia/endocarditis or poor clinical response should have repeat blood cultures. If a blood culture is positive for S aureus, minimum inhibitory concentration (MIC) susceptibility testing of the isolate should be performed using a standardized procedure, and diagnostic evaluation of the patient should be performed to rule out sequestered foci of infection.
The recommended treatment for Staphylococcus aureus bacteruria is not explicitly stated in the provided drug labels. However, daptomycin is indicated for the treatment of Staphylococcus aureus bloodstream infections (bacteremia) in adult patients, including those with right-sided infective endocarditis, caused by methicillin-susceptible and methicillin-resistant isolates 1.
- Key considerations:
- Daptomycin is not indicated for the treatment of pneumonia or left-sided infective endocarditis due to S. aureus.
- Patients with persisting or relapsing S. aureus bacteremia/endocarditis should undergo repeat blood cultures and diagnostic evaluation to rule out sequestered foci of infection 1.
From the Research
The recommended treatment for Staphylococcus aureus bacteriuria is a 7-14 day course of antibiotics, with first-line options including trimethoprim-sulfamethoxazole, nitrofurantoin, or cephalexin, and vancomycin or linezolid for methicillin-resistant S. aureus (MRSA), as supported by the most recent study 2. When considering treatment for Staphylococcus aureus bacteriuria, it's essential to determine whether it represents true infection or colonization.
- For symptomatic urinary tract infections caused by S. aureus, a 7-14 day course of antibiotics is typically recommended.
- First-line options include:
- Trimethoprim-sulfamethoxazole (TMP-SMX) at a dose of 160/800 mg twice daily
- Nitrofurantoin 100 mg four times daily
- Cephalexin 500 mg four times daily
- For methicillin-resistant S. aureus (MRSA), options include:
- TMP-SMX
- Vancomycin or linezolid in severe cases It's crucial to note that asymptomatic S. aureus bacteriuria often doesn't require treatment unless the patient is pregnant, undergoing urologic procedures, or has specific risk factors like indwelling catheters, as suggested by 3. When S. aureus is found in urine, clinicians should consider whether it represents hematogenous spread from another infection site, particularly in patients with risk factors for bacteremia, and obtain blood cultures if systemic infection is suspected, as recommended by 2. Treatment should be guided by antimicrobial susceptibility testing, as resistance patterns vary geographically, and S. aureus in the urinary tract can form biofilms, particularly with indwelling catheters, which may reduce antibiotic effectiveness and necessitate catheter removal when possible, as discussed in 4 and 5. The management of Staphylococcus aureus bacteriuria should prioritize the patient's clinical context, including the presence of symptoms, underlying medical conditions, and risk factors for complications, as emphasized by 6.