What is the recommended antibiotic coverage for Gram-positive (Gram+) cocci?

From the Guidelines

Gram-positive cocci (GPC) antibiotic coverage is recommended with agents such as linezolid, vancomycin, or daptomycin.

Recommended Antibiotics

• For MRSA skin and soft-tissue infections, oral antibiotics such as linezolid, trimethoprim-sulfamethoxazole (TMP-SMX), tetracyclines (doxycycline or minocycline), or tedizolid can be used 1.
• For intravenous (IV) antibiotic coverage of MRSA, agents such as daptomycin (10 mg/kg/dose IV once daily), IV linezolid, IV ceftaroline, IV dalbavancin, IV vancomycin, IV tigecycline, or IV tedizolid are recommended 1.
• For vancomycin-resistant Enterococcus (VRE) infections, treatment with linezolid or tigecycline is appropriate 1.

Key Considerations

• The choice of antibiotic should be based on the severity of the infection, patient comorbidities, and local resistance patterns.
• Empirical coverage of Enterococci is not generally recommended for patients with community-acquired infections, but should be considered in hospital-acquired infections or in patients with risk factors for VRE infection 1.
• Combination therapy may be necessary for infections presumed to be caused by more than one organism, or when the pathogen has a high potential for developing resistance 1.
• Narrower-spectrum agents are preferable when culture and sensitivity results are available, to reduce the likelihood of antibiotic resistance 1.

From the Research

Recommended Antibiotic Coverage for Gram-positive (Gram+) Cocci

The recommended antibiotic coverage for Gram-positive (Gram+) cocci includes several options, depending on the specific type of infection and the susceptibility of the pathogen. Some of the key antibiotics used to treat Gram-positive cocci include:

• Daptomycin, which has been shown to be effective against a wide range of Gram-positive pathogens, including methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) 2, 3
• Linezolid, which is a oxazolidinone antibiotic that has been shown to be effective against Gram-positive cocci, including MRSA and VRE 2, 3, 4
• Quinupristin/dalfopristin, which is a streptogramin antibiotic that has been shown to be effective against Gram-positive cocci, including MRSA and VRE 2, 4
• Vancomycin, which is a glycopeptide antibiotic that has been shown to be effective against Gram-positive cocci, including MRSA, but its use is often limited due to the emergence of VRE 5
• Tedizolid, which is a new oxazolidinone antibiotic that has been shown to be effective against Gram-positive cocci, including MRSA 6
• Dalbavancin, which is a lipoglycopeptide antibiotic that has been shown to be effective against Gram-positive cocci, including MRSA 2
• Tigecycline, which is a glycylcycline antibiotic that has been shown to be effective against Gram-positive cocci, including MRSA 2, 4

Factors to Consider When Selecting Antibiotic Coverage

When selecting antibiotic coverage for Gram-positive cocci, several factors should be considered, including:

• The type of infection and the suspected pathogen
• The susceptibility of the pathogen to different antibiotics
• The severity of the infection and the patient's overall health
• The potential for antibiotic resistance and the need for combination therapy
• The availability of new antibiotics and their potential uses 6