What is the treatment for Staphylococcus (Staph) empyema?

From the Guidelines

The treatment of staphylococcus empyema requires a combination of antibiotic therapy and drainage procedures, with empirical therapy for MRSA recommended pending sputum and/or blood culture results, as stated in the guidelines by the Infectious Diseases Society of America 1. The initial management should include chest tube drainage to evacuate the infected pleural fluid, followed by appropriate antibiotics.

• For methicillin-resistant Staphylococcus aureus (MRSA), IV vancomycin or linezolid 600 mg PO/IV twice daily is recommended for 7-21 days, depending on the extent of infection, as per the guidelines 1.
• Drainage is essential because antibiotics alone cannot penetrate the thick pleural fluid effectively. Some key points to consider in the treatment of staphylococcus empyema include:
• The use of antimicrobial therapy against MRSA in conjunction with drainage procedures, as recommended in the guidelines 1.
• The potential need for intrapleural fibrinolytic therapy or surgical intervention in cases of loculated or organized empyema.
• The importance of early intervention in the treatment of staphylococcal empyema to reduce morbidity and mortality. The choice of antibiotic therapy should be guided by the results of sputum and/or blood cultures, as well as the susceptibility of the MRSA strain, with vancomycin or linezolid being suitable options, as stated in the guidelines by the Infectious Diseases Society of America 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Bacteriologic studies to determine the causative organisms and their susceptibility to oxacillin should always be performed. Duration of therapy varies with the type of severity of infection as well as the overall condition of the patient, therefore it should be determined by the clinical and bacteriological response of the patient In severe staphylococcal infections, therapy with oxacillin should be continued for at least 14 days. RECOMMENDED DOSAGES FOR OXACILLIN FOR INJECTION, USP 1 gram IM or IV every 4 to 6 hours (severe infections) 100 mg/kg/day IM or IV in equally divided doses every 4 to 6 hours (severe infections)

The treatment of staphylococcus empyema with oxacillin should be based on the severity of the infection and the patient's overall condition.

• The recommended dosage for severe infections is 1 gram IM or IV every 4 to 6 hours or 100 mg/kg/day IM or IV in equally divided doses every 4 to 6 hours.
• Therapy should be continued for at least 14 days in severe staphylococcal infections.
• The treatment should be determined by the clinical and bacteriological response of the patient 2.

From the Research

Treatment Options for Staphylococcus Empyema

• The treatment of Staphylococcus empyema, particularly methicillin-resistant Staphylococcus aureus (MRSA) empyema, includes drainage and specific antibiotics such as vancomycin and linezolid 3, 4.
• However, there are increasing incidences of empyema refractory to vancomycin and linezolid, and daptomycin has been shown to be effective in treating MRSA empyema, especially in cases refractory to vancomycin 3, 4.
• Daptomycin can penetrate the pleural space and has been used to successfully treat MRSA empyema refractory to linezolid and vancomycin-resistant enterococcus (VRE) empyema 3.

Antibiotic Treatment for MRSA Infections

• The glycopeptide drug vancomycin is the most common drug used to treat severe MRSA infections, but other classes of antimicrobials are also available, including daptomycin, ceftaroline, and linezolid 5, 6.
• Treatment options for persistent MRSA bacteremia or bacteremia due to vancomycin-intermediate or vancomycin-resistant strains include daptomycin, ceftaroline, and combination therapies 6, 7.

Considerations for Treatment

• The choice of antibiotic treatment for Staphylococcus empyema should take into account the susceptibility of the isolate, the severity of the infection, and the patient's clinical condition 5, 7.
• Further comparative trials are needed to establish a preferred regimen and create a universal treatment algorithm for persistent MRSA bacteremia 7.