Table 3 Treatment recommendations for MRSA bacteremia
Condition | IDSA [8] | |
|---|---|---|
Uncomplicated bacteremia | Vancomycin or daptomycin 6 mg/kg/dose IV once daily for 2 weeks | Vancomycin doses to trough plasma concentration of 15–20 mg/L or teicoplanin if nephrotoxicity is a concern (daptomycin if vancomycin is poorly tolerated) for 10–14 days Consider switching to linezolid PO in patients with a rapid response and negative cultures after catheter removal |
Complicated bacteremia | Vancomycin or daptomycin 6 mg/kg/dose IV once daily for 4–6 weeks, depending on extent of infection | Vancomycin, but switch to daptomycin if there is poor response or use daptomycin first-line in patients with life-threatening infection, renal impairment, previous glycopeptide use, or vancomycin resistance or reduced susceptibility Treat for 4–6 weeks |
Infective endocarditis, native valve | Vancomycin or daptomycin 6 mg/kg/dose IV once daily for 6 weeks | Vancomycin 30–60 mg/kg/day IV in 2–3 doses for 4–6 weeks Alternative therapies: daptomycin 10 mg/kg/day IV once daily for 4–6 weeks or TMP/SMX + clindamycin |
Infective endocarditis, prosthetic valve | Vancomycin IV + rifampin 300 mg PO/IV for ≥6 weeks + gentamicin 1 mg/kg/dose IV q8h for 2 weeks | Vancomycin 30–60 mg/kg/day IV in 2–3 doses for ≥6 weeks + rifampin 900–1200 mg IV or orally in 2–3 doses for ≥6 weeks and gentamicin 3/mg/kg/day IV or IM in 1–2 doses for 2 weeks |
Infective endocarditis, right-sided | Vancomycin 15 mg/kg q12h for 6 weeks or daptomycin ≥6 mg/kg/day for 4–6 weeks if patient has renal impairment, sustained bacteremia for >7 days, infection with a VISA strain Optional addition of short-term gentamicin to vancomycin Alternative option: vancomycin + rifampin | |
Infective endocarditis, left-sided | Vancomycin 15 mg/kg q12h for 4–6 weeks with early and careful attention to culture results Switch to high-dose daptomycin (10 mg/kg/day) if no response to vancomycin and isolate is susceptible Optional addition of short-term gentamicin to vancomycin Alternative option: vancomycin + rifampin | |
Persistent bacteremia, despite vancomycin treatment | If isolate is susceptible, high-dose daptomycin (10 mg/kg/day) + another agenta If isolate has reduced susceptibility to vancomycin and daptomycin, options for monotherapy or combination therapy are quinupristin/dalfopristin 7.5 mg/kg/dose IV q8h, linezolid 600 mg PO/IV bid, or telavancin 10 mg/kg/dose IV od | Daptomycin 10 mg/kg/day if isolates susceptible, possibly in combination with another agent (e.g., gentamicin, rifampicin, linezolid, a beta-lactam, or trimethoprim-sulfamethoxazole) Options for agents with reduced susceptibility to daptomycin or vancomycin, including quinupristin/dalfopristin, linezolid, or telavancin |