From the Guidelines
Effective IV antibiotics against Staphylococcus aureus include vancomycin, linezolid, daptomycin, telavancin, and clindamycin.
Key Points:
- Vancomycin is a recommended option for empirical therapy for MRSA in hospitalized patients with complicated skin and soft tissue infections (SSTIs) 1, 2.
- Linezolid has been shown to be effective in the treatment of SSTIs, including those caused by MRSA, and has a similar efficacy to vancomycin 3.
- Daptomycin has proven efficacy in patients with Gram-positive complicated SSTIs, including those caused by S. aureus resistant to methicillin 3.
- Telavancin is another option for the treatment of complicated SSTIs, including those caused by MRSA 1, 2.
- Clindamycin can be used as an alternative option, but its use is limited by the potential for inducible resistance in MRSA strains 1, 2, 4.
Dosage and Administration:
- Vancomycin: 30 mg/kg/d in 2 divided doses IV 2.
- Linezolid: 600 mg every 12 hours IV or PO 2, 3.
- Daptomycin: 4 mg/kg every 24 hours IV 2, 3.
- Telavancin: 10 mg/kg every 24 hours IV 1, 2.
- Clindamycin: 600 mg every 8 hours IV or 300-450 mg every 6 hours PO 1, 2, 4.
From the Research
Effective IV Antibiotics for Staphylococcus aureus
The following IV antibiotics are effective against Staphylococcus aureus:
- For methicillin-susceptible S. aureus (MSSA) infections: + Penicillinase-resistant penicillins (flucloxacillin, dicloxacillin) 5 + First generation cephalosporins (cefazolin, cephalothin and cephalexin) 5 + Clindamycin, lincomycin, and erythromycin for less serious infections such as skin and soft tissue infections 5 + Daptomycin as a comparable alternative to anti-staphylococcal beta-lactam (ASBL) antibiotics 6
- For methicillin-resistant S. aureus (MRSA) infections: + Vancomycin or teicoplanin for serious infections 5, 7, 8 + Linezolid, quinupristin/dalfopristin, and daptomycin for certain cases 5, 8 + Dalbavancin and oritavancin as long-acting lipoglycopeptides for acute bacterial skin and skin-structure infections 9
Specific Clinical Syndromes
For specific clinical syndromes, the following IV antibiotics may be used: