From the Guidelines
For skin infections initially treated with intravenous vancomycin, the most appropriate oral step-down option is linezolid 600mg twice daily for 7-14 days, due to its excellent bioavailability and tissue penetration, as recommended by the Infectious Diseases Society of America 1. When considering oral step-down options, it's essential to choose an antibiotic that is effective against the specific pathogen and its susceptibilities. The options include linezolid, trimethoprim-sulfamethoxazole (TMP-SMX), doxycycline, or clindamycin.
- Linezolid is often preferred for MRSA infections due to its excellent bioavailability and tissue penetration.
- TMP-SMX (1-2 double-strength tablets twice daily) is another effective option for MRSA.
- Doxycycline 100mg twice daily or clindamycin 300-450mg three times daily are alternatives when appropriate. The choice should be guided by culture results when available, patient allergies, and local resistance patterns.
- The total treatment duration for skin infections typically ranges from 7-14 days, depending on infection severity and clinical response.
- Patients should complete the full course of antibiotics even if symptoms improve quickly.
- The transition from IV to oral therapy is appropriate when the patient shows clinical improvement, including decreased erythema, swelling, and fever resolution, and can tolerate oral medications, as stated in the clinical practice guidelines by the Infectious Diseases Society of America 1.
From the Research
Vancomycin for Skin Infections
- Vancomycin is commonly used to treat skin and soft-tissue infections (SSIs), particularly those caused by methicillin-resistant Staphylococcus aureus (MRSA) 2.
- However, its use has been questioned due to concerns about its efficacy, tolerability, and pharmacokinetic/pharmacodynamic profile 2.
- Meta-analyses have shown better clinical and microbiological outcomes for newer drugs approved for the treatment of SSI, including those sustained by MRSA, compared to vancomycin 2.
Oral Vancomycin for Clostridioides difficile Infection
- Oral vancomycin is a preferred treatment for Clostridioides difficile infection (CDI), regardless of disease severity 3.
- The optimal dose of oral vancomycin for CDI treatment is not well established, with studies showing equivalent outcomes between low-dose (125mg) and high-dose (250mg or 500mg) regimens 4.
- Oral vancomycin has been shown to be effective in preventing future CDI in patients with prior CDI who require systemic antimicrobial therapy, but not for primary prevention of CDI 5.