Bench-to-bedside review: Understanding the impact of resistance and virulence factors on methicillin-resistant Staphylococcus aureus infections in the intensive care unit

Table 1 Antibiotics currently available for the treatment of serious methicillin-resistant S. aureus infections

Antibiotic	Primary indications	Daily dose^a	Volume of distribution (L/kg)	Elimination half-life (hr)	Protein binding (%)	Main toxicity
Vancomycin	Pneumonia	30 mg/kg/day	0.2 to 1.25	4 to 6	30 to 55	Nephrotoxicity (higher doses)
	Skin/soft tissues					Thrombocytopenia
	Bacteremia
Linezolid	Pneumonia	600 mg q 12 h	0.5 - 0.6	5	31	Myelosuppression (prolonged duration generally >2 weeks)
	Skin/soft tissues					Lactic acidosis
						Peripheral and optic neuropathy
						Serotonin syndrome
Tigecycline	Skin/soft tissues	100 mg load	7 to 10	37 to 66	71 to 89	Nausea
	Intra-abdominal	50 mg q 12 h				Vomiting
						Photosensitivity
Daptomycin	Bacteremia	Bacteremia: 6 mg/kg q 24 h	0.09	8 to 9	92	Muscle toxicity
	Skin/soft tissues	Skin/soft tissues: 4 mg/kg q 24 h				CPK elevation
Quinupristin/dalfopristin	Skin/soft tissues	7.5 mg/kg q 8 h (via central vein)	0.56 to 0.98	0.54 to 1.14	11 to 78	Phlebitis
						Arthralgias and myalgias
Ceftobiprole^b	Skin/soft tissues	500 mg q 8 h	0.25 to 0.30	3 to 4	16	Allergic reactions
Ceftaroline^c	Skin/soft tissues Pneumonia	600 mg q 12 h	0.22 to 0.25	2.5 to 3	18	Allergic reactions
Dalbavancin^c	Skin/soft tissues	1,000 mg day 1	0.011	147 to 258	93	Nausea
		500 mg weekly				Vomiting
Oritavancin^c	Skin/soft tissues	1.5 to 3 mg/kg q 24 h	0.65 to 1.92	195	90	Nausea
						Vomiting
Telavancin^c	Skin/soft tissues Pneumonia	7.5 to 10 mg/kg day	0.1	7 to 9	93	Renal thrombocytopenia
Iclaprim^d	Skin/soft tissues	0.8 mg/kg q 12 h	1.15	2.5 to 4.1	93

^aDaily dose listed assumes normal kidney and liver function. ^bNot approved for clinical use in the US. Greater risk of clinical failure in ventilator-associated pneumonia compared to vancomycin plus ceftazadine. ^cNot approved for clinical use in the US at the time of writing. ^dNot approved for clinical use in the US. Failed to demonstrate non-inferiority against linezolid for treatment of complicated skin and skin structure infection. CPK, creatine phosphokinase.

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