From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
We should treat MRSE in patients with spine hardware and drainage with vancomycin as first-line therapy, considering the most recent evidence from 1 that highlights the importance of MRSA prophylaxis in reducing postoperative infections. The recommended treatment typically involves vancomycin, dosed at 15-20 mg/kg IV every 8-12 hours (adjusted based on renal function), with target trough levels of 15-20 μg/mL. Some key points to consider in the treatment of MRSE in patients with spine hardware and drainage include:
- Alternative options for treatment, such as daptomycin (6-8 mg/kg IV daily) or linezolid (600 mg IV/oral twice daily), may be considered based on patient-specific factors and antibiotic resistance patterns, as discussed in 2 and 3.
- Treatment duration is typically 6-8 weeks for hardware-associated infections, and the hardware may need to be removed if there is evidence of loosening, persistent infection despite appropriate antibiotics, or if the infection occurred soon after implantation.
- Surgical debridement is often necessary alongside antibiotic therapy to remove infected tissue and drainage, as highlighted in 4, which emphasizes the importance of conservative management with antibiotics for isolated drainage.
- Infectious disease consultation is recommended to optimize the antibiotic regimen, given the complexity of MRSE infections and the potential for antibiotic resistance.
- MRSE forms biofilms on hardware surfaces, making these infections particularly difficult to treat, as antibiotics penetrate biofilms poorly, which is why prolonged therapy and sometimes hardware removal are necessary for complete eradication.