Staphylococcus aureus infection medical therapy: Difference between revisions

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{{Staphylococcus aureus infection}}
{{Staphylococcus aureus infection}}
{{CMG}}
{{CMG}}
==Medical Therapy==
===Antimicrobial Regimen===
:* [[Staphylococcus aureus]] treatment
::* 1. '''Infectious endocarditis'''<ref name="pmid15956145">{{cite journal| author=Baddour LM, Wilson WR, Bayer AS, Fowler VG, Bolger AF, Levison ME et al.| title=Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America. | journal=Circulation | year= 2005 | volume= 111 | issue= 23 | pages= e394-434 | pmid=15956145 | doi=10.1161/CIRCULATIONAHA.105.165564 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15956145  }} </ref>
:::* 1.1 In adults
::::* Preferred regimen (1): [[Vancomycin]] 15-20 mg/kg IV q8-12h
::::* Preferred regimen (2): [[Daptomycin]] 6mg/kg/dose IV qd
::* 2. '''Intravascular catheter-related infections'''<ref name="pmid19489710">{{cite journal| author=Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O'Grady NP et al.| title=Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2009 | volume= 49 | issue= 1 | pages= 1-45 | pmid=19489710 | doi=10.1086/599376 | pmc=PMC4039170 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19489710  }} </ref>
:::* 2.1 '''Methicillin susceptible Staphylococcus aureus (MSSA)'''
::::* Preferred regimen (1): [[Nafcillin]] 2 g IV q6h
::::* Preferred regimen (2): [[Oxacillin]] 2 g IV q6h
::::* Alternative regimen (1): [[Cefazolin]] 2 g IV q8h
::::* Alternative regimen (2): [[Vancomycin]] 15 mg/kg IV q12h
:::::* 2.1.1 '''Pediatric dose of Nafcillin''' 
::::::* 2.1.1.1 '''Neonates (< 4 weeks)'''
:::::::* For < 1200 g: [[Nafcillin]] 50 mg/kg/day q12h
:::::::* For ≤ 7 days of age and 1200–2000 g: [[Nafcillin]] 50 mg/kg/day q12h
:::::::* For ≤ 7 days of age and > 2000 g: [[Nafcillin]] 75 mg/kg/day q8h
:::::::* For > 7 days of age and 1200–2000 g: [[Nafcillin]] 75 mg/kg/day q8h
:::::::* For > 7 days of age and > 2000 g: [[Nafcillin]] 100 mg/kg/day q6h
::::::* 2.1.1.2 '''Infants and children (> 4 weeks)'''
:::::::* [[Nafcillin]] 100–200 mg/kg/day q4–6h
:::::* 2.1.2 '''Pediatric dose of Oxacillin'''
::::::* 2.1.2.1 '''Neonates (< 4 weeks)'''
:::::::* For < 1200 g: [[Oxacillin]] 50 mg/kg/day q12h
:::::::* For Postnatal age < 7 days and 1200–2000 g: [[Oxacillin]] 50–100 mg/kg/day q12h
:::::::* For Postnatal age < 7 days and > 2000 g: [[Oxacillin]] 75–150 mg/kg/day q8h
:::::::* For Postnatal age ≥ 7 days and 1200–2000 g: [[Oxacillin]] 75–150 mg/kg/day q8h
:::::::* For Postnatal age ≥ 7 days and > 2000 g: [[Oxacillin]] 100–200 mg/kg/day q6h
::::::* 2.1.2.2 '''Infants and children'''(> 4weeks)
:::::::* [[Oxacillin]] 150–200 mg/kg/day q4–6h
:::::* 2.1.3 '''Pediatric dose of Cefazolin'''
::::::* 2.1.3.1 '''Neonates (< 4 weeks)'''
:::::::* Postnatal age ≤ 7 days: [[Cefazolin]] 40 mg/kg/day q12h
:::::::* Postnatal age > 7 days and ≤ 2000 g: [[Cefazolin]] 40 mg/kg/day q12h
:::::::* Postnatal age > 7 days and > 2000 g: [[Cefazolin]] 60 mg/kg/day q8h
::::::* 2.1.3.2 '''Infants and children (> 4 weeks)'''
:::::::* [[Cefazolin]] 50 mg/kg/day q8h.
:::::* 2.1.4 '''Pediatric dose of Vancomycin'''
::::::* 2.1.4.1 '''Neonates (< 4 weeks)'''
:::::::* Postnatal age ≤ 7 days and < 1200 g: [[Vancomycin]] 15 mg/kg/day q24h.
:::::::* Postnatal age ≤ 7 days and 1200–2000 g: [[Vancomycin]] 10–15 mg/kg q12–18h.
:::::::* Postnatal age ≤ 7 days and > 2000 g: [[Vancomycin]] 10–15 mg/kg q8–12h.
:::::::* Postnatal age > 7 days and < 1200 g: [[Vancomycin]] 15 mg/kg/day q24h.
:::::::* Postnatal age > 7 days and 1200–2000 g: [[Vancomycin]] 10–15 mg/kg q8–12h.
:::::::* Postnatal age > 7 days and > 2000 g: [[Vancomycin]] 15–20 mg/kg q8h.
::::::* 2.1.4.2 '''Infants and children (> 4 weeks)'''
:::::::* [[Vancomycin]] 40 mg/kg/day q6–8h.
:::* 2.2 '''Methicillin resistant Staphylococcus aureus (MRSA)'''
::::* Preferred regimen (1): [[Vancomycin]] 15 mg/kg IV q12h 
::::* Preferred regimen (2): [[Daptomycin]] 6–8 mg/kg/day IV
::::* Preferred regimen (3): [[Linezolid]] 10 mg/kg IV/PO q12h 
::::* Preferred regimen (4): [[Vancomycin]] 15 mg/kg IV q12h {{and}} ([[Rifampicin]] IV or [[Gentamycin]] IV)
::::* Preferred regimen (5): [[Trimethoprim-Sulfamethoxazole]] 6–12 mg TMP/kg/day q12h alone (if susceptible)
:::::* 2.2.1 '''Pediatric dose of Linezolid'''
::::::* 2.2.1.1 '''Neonates (< 4 weeks)'''
:::::::* For < 1200 g: [[Linezolid]] 10 mg/kg q8–12h (note: q12h in patients < 34 weeks gestation and < 1 week of age).
:::::::* For < 7 days of age and ≥ 1200 g: [[Linezolid]] 10 mg/kg q8–12h (note: q12h in patients < 34 weeks gestation and < 1 week of age).
:::::::* For ≥ 7 days and ≥ 1200 g: [[Linezolid]] 10 mg/kg q8h
::::::* 2.2.1.2 '''Infants and children < 12 years (> 4 weeks)'''
:::::::* [[Linezolid]] 10 mg/kg q8h
::::::* 2.2.1.3 '''Children ≥ 12 years and adolescents'''
:::::::* [[Linezolid]] 10 mg/kg q12h
:::::* 2.2.2 '''Pediatric dose of Gentamycin'''
::::::* 2.2.2.1 '''Neonates (< 4 weeks)'''
:::::::* Premature neonates and < 1000 g: [[Gentamycin]] 3.5 mg/kg q24h
:::::::* < 1200 g: [[Gentamycin]] 2.5 mg/kg q18-24h.
:::::::* Postnatal age ≤ 7 days: [[Gentamycin]] 2.5 mg/kg q12h.
:::::::* Postnatal age > 7 days and 1200–2000 g: [[Gentamycin]] 2.5 mg/kg q8-12h.
:::::::* Postnatal age > 7 days and > 1200 g: [[Gentamycin]] 2.5 mg/kg q8h.
:::::::* Premature neonates with normal renal function: [[Gentamycin]] 3.5–4 mg/kg q24h.
:::::::* Term neonates with normal renal function: [[Gentamycin]] 3.5–5 mg/kg q24h.
::::::* 2.2.2.2 '''Infants and children < 5 years (> 4 weeks)'''
:::::::* [[Gentamycin]] 2.5 mg/kg q8h; qd dosing in patients with normal renal function, [[Gentamycin]] 5–7.5 mg/kg q24h.
::::::* 2.2.2.3 '''Children ≥ 5 years '''
:::::::* [[Gentamycin]] 2–2.5 mg/kg q8h; qd with normal renal function, [[Gentamycin]] 5–7.5 mg/kg q24h.
:::::* 2.2.3 '''Pediatric dose of Trimethoprim-Sulfamethoxazole'''
::::::* 2.2.3.1 '''Infants > 2 months of age and children of mild-to-moderate infections '''
:::::::* [[Trimethoprim-Sulfamethoxazole]] 6–12 mg TMP/kg/day q12h; serious infection- [[Trimethoprim-Sulfamethoxazole]] 15–20 mg TMP/kg/day  q6-8h.
::* 3. '''Cellulitis'''<ref name="pmid24973422">{{cite journal| author=Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL et al.| title=Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2014 | volume= 59 | issue= 2 | pages= e10-52 | pmid=24973422 | doi=10.1093/cid/ciu444 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24973422  }} </ref>
::: 3.1 '''Purulent cellulitis''' (defined as cellulitis associated with purulent drainage or exudate in the absence of a drainable abscess)
::::* 3.1.1 '''In adults'''
:::::* Preferred regimen (1): [[Clindamycin]] 300–450 mg PO tid
:::::* Preferred regimen (2): [[Trimethoprim-Sulfamethoxazole]] 1–2 DS (double strength) tab PO bid
:::::* Preferred regimen (3): [[Doxycycline]] 100 mg PO bid
:::::* Preferred regimen (4): [[Minocycline]] 200 mg as a single dose {{then}} 100 mg PO bid
:::::* Preferred regimen (5): [[Linezolid]] 600 mg PO bid
:::* 3.1.2 '''In children'''
::::* Preferred regimen (1): [[Clindamycin]] 10–13 mg/kg PO q6–8h, not to exceed 40 mg/kg/day
::::* Preferred regimen (2): [[Trimethoprim]] 4–6 mg/kg, [[Sulfamethoxazole]] 20–30 mg/kg PO q12h 
::::* Preferred regimen (3)
:::::* 3.1 If patient body weight < 45kg then [[Doxycycline]] 2 mg/kg PO q12h
:::::* 3.2 If patient body weight 45kg then [[Doxycycline]] adult dose 
::::* Preferred regimen (4): [[Minocycline]] 4 mg/kg PO 200 mg as a single dose, {{then}} [[Minocycline]] 2 mg/kg PO q12h 
::::* Preferred regimen (5): [[Linezolid]] 10 mg/kg PO q8h, (max: 600 mg)
::* 3.2 '''Nonpurulent cellulitis''' (defined as cellulitis with no purulent drainage or exudate and no associated abscess)
:::* 3.2.1 '''In adults'''
::::* Preferred regimen (1): Beta-lactam (eg, [[Cephalexin]] and [[Dicloxacillin]]) 500 mg PO qid
::::* Preferred regimen (2): [[Clindamycin]] 300–450 mg PO tid
::::* Preferred regimen (3): [[Amoxicillin]] 500 PO mg tid
::::* Preferred regimen (4): [[Linezolid]] 600 mg PO bid
::::* Note (1): Empirical therapy for beta-hemolytic streptococci is recommended. Empirical coverage for CA-MRSA is recommended in patients who do not respond to beta-lactam therapy and may be considered in those with systemic toxicity.
::::* Note (2): Provide coverage for both beta-hemolytic streptococci and CA-MRSA beta-lactam (eg, [[Amoxicillin]]) with or without [[Trimethoprim-Sulfamethoxazole]] or a [[Tetracycline]]
:::* 3.2.2 '''In children'''
::::* Preferred regimen (1): [[Clindamycin]] 10–13 mg/kg PO q6–8h, not to exceed 40 mg/kg/day 
::::* Preferred regimen (2): [[Trimethoprim]] 4–6 mg/kg, [[Sulfamethoxazole]] 20–30 mg/kg PO q12h 
::::* Preferred regimen (3): [[Linezolid]] 10 mg/kg PO q8h, not to exceed 600 mg
::::* Note (1): [[Clindamycin]] causes Clostridium difficile–associated disease may occur more frequently, compared with other oral agents.
::::* Note (2): [[Trimethoprim-Sulfamethoxazole]] not recommended for women in the third trimester of pregnancy and for children ,2 months of age.
::::* Note (3): [[Tetracyclines]] are not recommended for children under 8 years of age and are pregnancy category D.
::* 4. '''Brain abscess'''<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref><ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref><ref>{{Cite journal| doi = 10.1093/cid/ciq146| issn = 1537-6591| volume = 52| issue = 3| pages = –18-55| last1 = Liu| first1 = Catherine| last2 = Bayer| first2 = Arnold| last3 = Cosgrove| first3 = Sara E.| last4 = Daum| first4 = Robert S.| last5 = Fridkin| first5 = Scott K.| last6 = Gorwitz| first6 = Rachel J.| last7 = Kaplan| first7 = Sheldon L.| last8 = Karchmer| first8 = Adolf W.| last9 = Levine| first9 = Donald P.| last10 = Murray| first10 = Barbara E.| last11 = J Rybak| first11 = Michael| last12 = Talan| first12 = David A.| last13 = Chambers| first13 = Henry F.| last14 = Infectious Diseases Society of America| title = Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2011-02-01| pmid = 21208910}}</ref>
:::* 4.1 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
::::* 4.1.1 '''In adults'''
:::::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h for 4–6 weeks
:::::* Alternative regimen (1): [[Linezolid]] 600 mg PO/IV q12h for 4–6 weeks 
:::::* Alternative regimen (2): [[Trimethoprim-Sulfamethoxazole]] 5 mg/kg PO/IV q8–12h for 4–6 weeks
::::* 4.1.2 '''In children'''
:::::* Preferred regimen (1): [[Vancomycin]]15 mg/kg/dose IV q6h
:::::* Preferred regimen (2): [[Linezolid]] 10 mg/kg/dose PO/IV q8h
:::::* Note: Consider the addition of [[Rifampin]] 600 mg qd {{or}} 300–450 mg bid to [[Vancomycin]].
:::* 4.2 '''Methicillin-susceptible Staphylococcus aureus (MSSA)'''
::::* Preferred regimen (1): [[Nafcillin]] 2 g IV q4h 
::::* Preferred regimen (2): [[Oxacillin]] 2 g IV q4h
::::* Alternative regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h
::* 5. '''Cerebrospinal fluid shunt infection'''<ref>{{Cite journal| doi = 10.1086/425368| issn = 1537-6591| volume = 39| issue = 9| pages = 1267–1284| last1 = Tunkel| first1 = Allan R.| last2 = Hartman| first2 = Barry J.| last3 = Kaplan| first3 = Sheldon L.| last4 = Kaufman| first4 = Bruce A.| last5 = Roos| first5 = Karen L.| last6 = Scheld| first6 = W. Michael| last7 = Whitley| first7 = Richard J.| title = Practice guidelines for the management of bacterial meningitis| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2004-11-01| pmid = 15494903}}</ref><ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
:::* 5.1 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
::::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h with or without [[Rifampin]] 600 mg IV or PO q24h
::::* Note: Shunt removal is recommended, and it should not be replaced until cerebrospinal fluid cultures are repeatedly negative.
:::* 5.2 '''Methicillin-susceptible Staphylococcus aureus (MSSA)'''
::::* Preferred regimen (1): [[Nafcillin]] 2 g IV q4h with or without [[Rifampin]] 600 mg IV/PO q24h
::::* Preferred regimen (2): [[Oxacillin]] 2 g IV q4h
::* 6. '''Spinal epidural abscess'''<ref>{{cite book | last = Kasper | first = Dennis | title = Harrison's principles of internal medicine | publisher = McGraw Hill Education | location = New York | year = 2015 | isbn = 978-0071802154 }}</ref><ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref><ref>{{Cite journal| doi = 10.1056/NEJMra055111| issn = 1533-4406| volume = 355| issue = 19| pages = 2012–2020| last = Darouiche| first = Rabih O.| title = Spinal epidural abscess| journal = The New England Journal of Medicine| date = 2006-11-09| pmid = 17093252}}</ref><ref>{{Cite journal| doi = 10.1093/cid/ciq146| issn = 1537-6591| volume = 52| issue = 3| pages = –18-55| last1 = Liu| first1 = Catherine| last2 = Bayer| first2 = Arnold| last3 = Cosgrove| first3 = Sara E.| last4 = Daum| first4 = Robert S.| last5 = Fridkin| first5 = Scott K.| last6 = Gorwitz| first6 = Rachel J.| last7 = Kaplan| first7 = Sheldon L.| last8 = Karchmer| first8 = Adolf W.| last9 = Levine| first9 = Donald P.| last10 = Murray| first10 = Barbara E.| last11 = J Rybak| first11 = Michael| last12 = Talan| first12 = David A.| last13 = Chambers| first13 = Henry F.| last14 = Infectious Diseases Society of America| title = Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2011-02-01| pmid = 21208910}}</ref>
:::* 6.1 '''Penicillin-susceptible Staphylococcus aureus or Streptococcus'''
::::* Preferred regimen: [[Penicillin G]] 4 MU IV q4h for 2–4 weeks, {{then}} PO to complete 6–8 weeks
:::* 6.2 '''Methicillin-susceptible Staphylococcus aureus or Streptococcus'''
::::* Preferred regimen (1): [[Cefazolin]] 2 g IV q8h for 2–4 weeks, {{then}} PO to complete 6–8 weeks 
::::* Preferred regimen (2): [[Nafcillin]] 2 g IV q4h for 2–4 weeks, {{then}} PO to complete 6–8 weeks
::::* Preferred regimen (3): [[Oxacillin]] 2 g IV q4h for 2–4 weeks, {{then}} PO to complete 6–8 weeks
::::* Alternative regimen: [[Clindamycin]] 600 mg IV q6h for 2–4 weeks, {{then}} PO to complete 6–8 weeks
:::* 6.3 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
::::* 6.3.1 '''In adults'''
:::::* Preferred regimen: [[Vancomycin]] loading dose 25–30 mg/kg IV {{then}} [[Vancomycin]] 15–20 mg/kg IV q8–12h for 2–4 weeks, {{then}} PO to complete 6–8 weeks
:::::* Alternative regimen (1): [[Linezolid]] 600 mg PO/IV q12h for 4–6 weeks
:::::* Alternative regimen (2): [[Trimethoprim-Sulfamethoxazole]] 5 mg/kg PO/IV q8–12h for 4–6 weeks
::::* 6.3.2 '''Pediatric dose'''
:::::* Preferred regimen (1): [[Vancomycin]] 15 mg/kg IV q6h
:::::* Preferred regimen (2): [[Linezolid]] 10 mg/kg PO/IV q8h
:::::* Note: Consider the addition of [[Rifampin]] 600 mg qd or 300–450 mg bid to [[Vancomycin]] in adult patients..
::* 7. ''' Bacterial meningitis'''
:::* 7.1 '''Methicillin susceptible Staphylococcus aureus (MSSA)'''
::::* Preferred regimen (1): [[Nafcillin]] 9–12 g/day IV q4h
::::* Preferred regimen (2): [[Oxacillin]] 9–12 g/day IV q4h
::::* Alternative regimen (1): [[Vancomycin]] 30–45 mg/kg/day IV q8–12h
::::* Alternative regimen (2): [[Meropenem]] 6 g/day IV q8h
:::* 7.2 '''Methicillin resistant Staphylococcus aureus (MRSA)'''
::::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h
::::* Alternative regimen (1): [[Trimethoprim-Sulfamethoxazole]] 10–20 mg/kg/day q6–12h 
::::* Alternative regimen (2): [[Linezolid]] 600 mg IV q12h
::::* Note: Consider the addition of [[Rifampin]] 600 mg qd or 300–450 mg bid to [[Vancomycin]] in adult patients.
::* 8. '''Septic thrombosis of cavernous or dural venous sinus'''<ref>{{Cite journal| doi = 10.1093/cid/ciq146| issn = 1537-6591| volume = 52| issue = 3| pages = –18-55| last1 = Liu| first1 = Catherine| last2 = Bayer| first2 = Arnold| last3 = Cosgrove| first3 = Sara E.| last4 = Daum| first4 = Robert S.| last5 = Fridkin| first5 = Scott K.| last6 = Gorwitz| first6 = Rachel J.| last7 = Kaplan| first7 = Sheldon L.| last8 = Karchmer| first8 = Adolf W.| last9 = Levine| first9 = Donald P.| last10 = Murray| first10 = Barbara E.| last11 = J Rybak| first11 = Michael| last12 = Talan| first12 = David A.| last13 = Chambers| first13 = Henry F.| last14 = Infectious Diseases Society of America| title = Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2011-02-01| pmid = 21208910}}</ref>
:::* 8.1 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
::::* 8.1.1 '''In adults'''
:::::* Preferred regimen: [[Vancomycin]] 15–20 mg/kg IV q8–12h for 4–6 weeks
:::::* Alternative regimen (1): [[Linezolid]] 600 mg PO/IV q12h for 4–6 weeks 
:::::* Alternative regimen (2): [[Trimethoprim-Sulfamethoxazole]] 5 mg/kg/dose PO/IV q8–12h for 4–6 weeks
::::* 8.1.2 '''Pediatric dose'''
:::::* Preferred regimen (1): [[Vancomycin]] 15 mg/kg IV q6h
:::::* Preferred regimen (2): [[Linezolid]] 10 mg/kg PO/IV q8h
:::::* Note (1): Surgical evaluation for incision and drainage of contiguous sites of infection or abscess is recommended whenever possible.
:::::* Note (2): Consider the addition of [[Rifampin]] 600 mg qd or 300–450 mg bid to [[Vancomycin]].
::* 9. '''Subdural empyema'''
:::* 9.1 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''<ref>{{Cite journal| doi = 10.1093/cid/ciq146| issn = 1537-6591| volume = 52| issue = 3| pages = –18-55| last1 = Liu| first1 = Catherine| last2 = Bayer| first2 = Arnold| last3 = Cosgrove| first3 = Sara E.| last4 = Daum| first4 = Robert S.| last5 = Fridkin| first5 = Scott K.| last6 = Gorwitz| first6 = Rachel J.| last7 = Kaplan| first7 = Sheldon L.| last8 = Karchmer| first8 = Adolf W.| last9 = Levine| first9 = Donald P.| last10 = Murray| first10 = Barbara E.| last11 = J Rybak| first11 = Michael| last12 = Talan| first12 = David A.| last13 = Chambers| first13 = Henry F.| last14 = Infectious Diseases Society of America| title = Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2011-02-01| pmid = 21208910}}</ref>
::::* 9.1.1 '''In adults'''
:::::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h for 4–6 weeks
:::::* Alternative regimen (1): [[Linezolid]] 600 mg PO/IV q12h for 4–6 weeks
:::::* Alternative regimen (2): [[Trimethoprim-Sulfamethoxazole]] 5 mg/kg PO/IV q8–12h for 4–6 weeks
::::* 9.1.2 '''In children'''
:::::* Preferred regimen (1): [[Vancomycin]] 15 mg/kg IV q6h
:::::* Preferred regimen (2): [[Linezolid]] 10 mg/kg PO/IV q8h
:::::* Note: Consider the addition of [[Rifampin]] 600 mg qd or 300–450 mg bid to [[Vancomycin]].
::* 10. ''' Acute conjunctivitis'''<ref>{{Cite journal| doi = 10.1001/jama.2013.280318| issn = 1538-3598| volume = 310| issue = 16| pages = 1721–1729| last1 = Azari| first1 = Amir A.| last2 = Barney| first2 = Neal P.| title = Conjunctivitis: a systematic review of diagnosis and treatment| journal = JAMA| date = 2013-10-23| pmid = 24150468| pmc = PMC4049531}}</ref>
:::* 10.1 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
::::* Preferred regimen: [[Vancomycin]] ointment 1% qid
::* 11. '''Appendicitis'''
:::* 11.1 '''Health care–associated complicated intra-abdominal infection'''<ref name="pmid20034345">{{cite journal| author=Solomkin JS, Mazuski JE, Bradley JS, Rodvold KA, Goldstein EJ, Baron EJ et al.| title=Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2010 | volume= 50 | issue= 2 | pages= 133-64 | pmid=20034345 | doi=10.1086/649554 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20034345  }} </ref>
::::* 11.1.1 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
:::::* Preferred regimen: [[Vancomycin]] 15–20 mg/kg IV q8–12h
::* 12. '''Diverticulitis'''
:::* 12.1 '''Health care–associated complicated intra-abdominal infection'''<ref name="pmid20034345">{{cite journal| author=Solomkin JS, Mazuski JE, Bradley JS, Rodvold KA, Goldstein EJ, Baron EJ et al.| title=Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2010 | volume= 50 | issue= 2 | pages= 133-64 | pmid=20034345 | doi=10.1086/649554 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20034345  }} </ref>
::::* 12.1.1 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
:::::* Preferred regimen: [[Vancomycin]] 15–20 mg/kg IV q8–12h.
::* 13. '''Peritonitis secondary to bowel perforation, peritonitis secondary to ruptured appendix, peritonitis secondary to ruptured  appendix, typhlitis'''
:::* 13.1 '''Health care–associated complicated intra-abdominal infection'''<ref name="pmid20034345">{{cite journal| author=Solomkin JS, Mazuski JE, Bradley JS, Rodvold KA, Goldstein EJ, Baron EJ et al.| title=Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2010 | volume= 50 | issue= 2 | pages= 133-64 | pmid=20034345 | doi=10.1086/649554 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20034345  }} </ref>
::::* 13.1.1 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
:::::* Preferred regimen: [[Vancomycin]] 15–20 mg/kg IV q8–12h
::* 14. '''Cystic fibrosis'''<ref name="pmid23540878">{{cite journal| author=Mogayzel PJ, Naureckas ET, Robinson KA, Mueller G, Hadjiliadis D, Hoag JB et al.| title=Cystic fibrosis pulmonary guidelines. Chronic medications for maintenance of lung health. | journal=Am J Respir Crit Care Med | year= 2013 | volume= 187 | issue= 7 | pages= 680-9 | pmid=23540878 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23540878  }} </ref>
:::* 14.1 '''Adults'''
::::* 14.1.1 '''If methicillin sensitive staphylococcus aureus'''
:::::* Preferred Regimen (1): [[Nafcillin]] 2 gm IV q4h
:::::* Preferred Regimen (2): [[Oxacillin]] 2 gm IV q4h
::::* 14.1.2 '''If methicillin resistant staphylococcus aureus'''
:::::* Preferred Regimen (1): [[Vancomycin]] 15-20 mg/kg IV q8-12h 
:::::* Preferred Regimen (2): [[Linezolid]] 600 mg PO/IV q12h
:::* 14.2 '''Pediatric'''
::::* 14.2.1 '''If methicillin sensitive staphylococcus aureus'''
:::::* Preferred Regimen (1): [[Nafcillin]] 5 mg/kg q6h (Age >28 days)
:::::* Preferred Regimen (2): [[Oxacillin]] 75 mg/kg q6h (Age >28 days)
::::* 14.2.2 '''If methicillin resistant staphylococcus aureus'''
:::::* Preferred Regimen (1): [[Vancomycin]] 40 mg/kg  q6-8h (Age >28 days)
:::::* Preferred Regimen (2): [[Linezolid]] 10 mg/kg PO/IV q8h (up to age 12)
::* 15. '''Bronchiectasis'''<ref name="pmid20627931">{{cite journal| author=Pasteur MC, Bilton D, Hill AT, British Thoracic Society Bronchiectasis non-CF Guideline Group| title=British Thoracic Society guideline for non-CF bronchiectasis. | journal=Thorax | year= 2010 | volume= 65 Suppl 1 | issue=  | pages= i1-58 | pmid=20627931 | doi=10.1136/thx.2010.136119 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20627931  }} </ref>
:::* 15.1 '''In adults'''
::::* 15.1.1 '''Recommended first-line treatment and length of treatment'''
:::::* 15.1.1.1 '''Methicillin-susceptible Staphylococcus aureus (MSSA)'''
::::::* Preferred regimen: [[Flucloxacillin]] 500 mg PO qds for 14 days
:::::* 15.1.1.2  '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
::::::* '''Patient's body weight is < 50 kg'''
:::::::* Preferred regimen: [[Rifampicin]] 450 mg PO qd {{and}} [[Trimethoprim]] 200 mg PO bd for 14 days
::::::* '''Patient's body weight is > 50 kg'''
:::::::* Preferred regimen: [[Rifampicin]] 600 mg PO qd {{and}} [[Trimethoprim]] 200 mg PO bd for 14 days
:::::* 15.1.1.3 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
::::::* Preferred regimen (1): [[Vancomycin]] 1 g IV bd (monitor serum levels and adjust dose accordingly)
::::::* Preferred regimen (2): [[Teicoplanin]] 400 mg qd for 14 days
::::* 15.1.2 '''Recommended second-line treatment and length of treatment'''
:::::* 15.1.2.1 '''Methicillin-susceptible Staphylococcus aureus (MSSA)'''
::::::* Preferred regimen: [[Clarithromycin]] 500 mg PO bd 14 days
:::::* 15.1.2.2 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
::::::* '''Patient's body weight is < 50 kg '''
:::::::* Preferred regimen: [[Rifampicin]] 450 mg PO qd {{and}} [[Doxycycline]] 200 mg PO qd for 14 days
::::::* '''Patient's body weight is > 50 kg'''
:::::::* Preferred regimen: [[Rifampicin]] 600 mg PO qd {{and}} [[Doxycycline]] 200 mg PO qd for 14 days
::::::* '''Third-line''': [[Linezolid]] 600 mg bd for 14 days
:::::* 15.1.2.3 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
::::::* Preferred regimen: [[Linezolid]] 600 mg IV bd for 14 days
:::* 15.2 '''In children'''
::::* 15.2.1 '''Recommended first-line treatment and length of treatment'''
:::::* 15.2.1.1 '''Methicillin-susceptible Staphylococcus aureus (MSSA)'''
::::::* Preferred regimen: [[Flucloxacillin]]
:::::* 15.2.1.2 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
::::::* 15.2.1.2.1 '''Children''' (< 12 yr)
:::::::* Preferred regimen: [[Trimethoprim]] 4-6 mg/kg/day PO q12h 
::::::* 15.2.1.2.2 '''Children''' (> 12 yr) 
:::::::* Preferred regimen (1): [[Trimethoprim]] 100-200 mg PO q12h 
:::::::* Preferred regimen (2): [[Rifampicin]] 450 mg PO od (or [[Rifampicin]] 600 mg PO od)
:::::* 15.2.1.3 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
::::::* Preferred regimen (1): [[Vancomycin]] 45-60 mg/kg/day IV q8-12h 
::::::* Preferred regimen (2): [[Teicoplanin]] 400 mg qd for 14 days
::::* 15.2.2 '''Recommended second-line treatment and length of treatment'''
:::::* 15.2.2.1 '''Methicillin-susceptible Staphylococcus aureus (MSSA)'''
::::::* Preferred regimen: [[Clarithromycin]] 15 mg/kg/day PO q12h 
:::::* 15.2.2.2 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
::::::* Preferred regimen (1): [[Rifampicin]] {{and}} [[Doxycycline]] 2-5 mg/kg/day PO/IV q12-24h  (max dose: 200 mg/24 hr) 
::::::* Preferred regimen (2): [[Rifampicin]] {{and}} [[Doxycycline]] 2-5 mg/kg/day PO/IV q12-24h  (max dose: 200 mg/24 hr) 
::::::* '''Third-line''': [[Linezolid]] 10 mg/kg PO/IV q12h
:::::* 15.2.2.3 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
::::::* Preferred regimen: [[Linezolid]] 10 mg/kg PO/IV q12h
:::*  15.3 '''Long-term oral antibiotic treatment'''
::::* 15.3.1 '''In adults'''
:::::* 15.3.1.1 '''Recommended first-line treatment and length of treatment'''
::::::* 15.3.1.1.1 '''Methicillin-susceptible Staphylococcus aureus (MSSA)'''
:::::::* Preferred regimen: [[Flucloxacillin]] 500 mg PO bd
:::::* 15.3.1.2 '''Recommended second-line treatment and length of treatment'''
::::::* 15.3.1.2.1 '''Methicillin-susceptible Staphylococcus aureus (MSSA)'''
:::::::* Preferred regimen: [[Clarithromycin]] 250 mg PO bd
::* 16. '''Empyema'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
:::* Preferred regimen (1): [[Nafcillin]]  2 gm IV q4h
:::* Preferred regimen (2): [[oxacillin]]  2 gm IV q4h (if MSSA)
:::* Alternative regimen (1): [[Vancomycin]]  1 gm IV q12h
:::* Alternative regimen (2): [[Linezolid]]  600 mg PO bid (if MRSA)
::* 17. '''Community-acquired pneumonia'''<ref name="pmid17278083">{{cite journal| author=Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC et al.| title=Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. | journal=Clin Infect Dis | year= 2007 | volume= 44 Suppl 2 | issue=  | pages= S27-72 | pmid=17278083 | doi=10.1086/511159 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17278083  }} </ref>
:::* 17.1 '''Methicillin-susceptible Staphylococcus aureus (MSSA)'''
::::* Preferred Regimen (1): [[Nafcillin]] 1000-2000 mg q4h 
::::* Preferred Regimen (2): [[Oxacillin]] 2 g IV q4h 
::::* Preferred Regimen (3): [[Flucloxacillin]] 250 mg IM/IV q6h
::::* Alternative Regimen (1): [[Cefazolin]] 500 mg IV q12h 
::::* Alternative Regimen (2): [[Clindamycin]] 150-450 mg PO q6-8h
:::* 17.2 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
::::* Preferred Regimen (1): [[Vancomycin]] 45-60 mg/kg/day q8-12h (max: 2000 mg/dose) for 7-21 days
::::* Preferred Regimen (2): [[Linezolid]] 600 mg PO/IV q12h for 10-14 days
::::* Alternative Regimen: [[Trimethoprim-Sulfamethoxazole]] 1-2 double-strength tablets (800/160 mg) q12-24h
::* 18. '''Olecranon bursitis or prepatellar bursitis'''
:::* 18.1 '''Methicillin-susceptible Staphylococcus aureus (MSSA)'''
::::* Preferred regimen (1): [[Nafcillin]] 2 g IV q4h 
::::* Preferred regimen (2): [[Oxacillin]] 2 g IV q4h
::::* Preferred regimen (3): [[Dicloxacillin]] 500 mg PO qid
:::* 18.2 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
::::* Preferred regimen (1): [[Vancomycin]] 1 g IV q12h
::::* Preferred regimen (2): [[Linezolid]] 600 mg PO qd
::::* Note: Initially aspirate q24h and treat for a minimum of 2–3 weeks.
::* 19. '''Septic arthritis'''
:::* 19.1 '''In adults'''
::::* 19.1.1 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
:::::* Preferred regimen: [[Vancomycin]] 15–20 mg/kg IV q8–12h
:::::* Alternative regimen (1): [[Daptomycin]] 6 mg/kg IV q24h in adults
:::::* Alternative regimen (2): [[Linezolid]] 600 mg PO/IV q12h
:::::* Alternative regimen (3): [[Clindamycin]] 600 mg PO/IV q8h
:::::* Alternative regimen (4): TMP-SMX 3.5–4.0 mg/kg PO/IV q8–12h
::::* 19.2.1 '''Methicillin-susceptible Staphylococcus aureus (MSSA)'''
:::::* Preferred regimen (1): [[Nafcillin]] 2 g IV q6h
:::::* Preferred regimen (2): [[Clindamycin]] 900 mg IV q8h
:::::* Alternative regimen (1): [[Cefazolin]] 0.25–1 g IV/IM q6–8h
:::::* Alternative regimen (2): [[Vancomycin]] 500 mg IV q6h or 1 g IV q12h
:::* 19.2 '''In childern'''
::::* Preferred regimen (1): [[Vancomycin]] 15 mg/kg IV q6h
::::* Preferred regimen (2): [[Daptomycin]] 6–10 mg/kg IV q24h
::::* Preferred regimen (3): [[Linezolid]] 10 mg/kg PO/IV q8h
::::* Preferred regimen (4): [[Clindamycin]] 10–13 mg/kg PO/IV q6–8h
::* 20. '''Septic arthritis, prosthetic joint infection (device-related osteoarticular infections)'''
:::* 20.1 ''' Methicillin-susceptible Staphylococcus aureus (MSSA)'''
::::* Preferred regimen (1): [[Nafcillin]] 2 g IV q4–6h
::::* Preferred regimen (2): [[Oxacillin]] 2 g IV q4–6h
::::* Alternative regimen (1): [[Cefazolin]] 1–2 g IV q8h 
::::* Alternative regimen (2): [[Ceftriaxone]] 2 g IV q24h
::::* Alternative regimen (if allergic to penicillins) (3): [[Clindamycin]] 900 mg IV q8h
::::* Alternative regimen (if allergic to penicillins) (4): [[Vancomycin]] 15–20 mg/kg IV q8–12h, (max: 2 g per dose)
:::* 20.2 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
::::* Early-onset (2 months after surgery) or acute hematogenous prosthetic joint infections involving a stable implant with short duration (< 3 weeks) of symptoms and debridement (but device retention)
::::* Preferred regimen: [[Vancomycin]] {{and}} [[Rifampin]] 600 mg PO qd or 300–450 mg PO bid for 2 weeks
::::* Alternative regimen (1): [[Daptomycin]] 6 mg/kg IV q24h {{and}} [[Rifampin]] 600 mg PO qd or 300–450 mg PO bid for 2 weeks
::::* Alternative regimen (2): [[Linezolid]] 600 IV q8h {{and}} [[Rifampin]] 600 mg PO qd or 300–450 mg PO bid for 2 weeks
::::* Note: The above regimen should be followed by [[Rifampin]] and a [[Fluoroquinolone]], TMP/SMX, a [[Tetracycline]] or [[Clindamycin]] for 3-6 months for hips and knees, respectively.
::* 21. '''Hematogenous osteomyelitis'''
:::* 21.1 '''Adult''' (> 21 yrs)
::::* 21.1.1 '''Methicillin-resistant Staphylococcus aureus (MRSA)''' possible
:::::* Preferred regimen: [[Vancomycin]] 1 gm IV q12h (if over 100 kg, 1.5 gm IV q12h)
::::* 21.1.2 '''Methicillin-resistant Staphylococcus aureus (MRSA)''' unlikely
:::::* Preferred regimen (1): [[Nafcillin]] 
:::::* Preferred regimen (2): [[Oxacillin]] 2 gm IV q4h
:::* 21.2 '''Children''' (> 4 months)-Adult
::::* 21.2.1 '''Methicillin-resistant Staphylococcus aureus (MRSA)''' possible
:::::* Preferred regimen: [[Vancomycin]] 40 mg IV q6–8h
::::* 21.2.2 '''Methicillin-resistant Staphylococcus aureus (MRSA)''' unlikely
:::::* Preferred regimen (1): [[Nafcillin]]
:::::* Preferred regimen (2): [[Oxacillin]] q6h (max. 8–12 gm per day)
:::::* Note: Add [[Ceftazidime]] 50 mg q8h or [[Cefepime]] 150 mg q8h if Gram negative bacilli on Gram stain 
:::* 21.3 '''Newborn''' (< 4 months.)
::::* 21.3.1 '''Methicillin-resistant Staphylococcus aureus (MRSA)''' possible
:::::* Preferred regimen (1): [[Vancomycin]] {{and}} [[Ceftazidime]] 2 gm IV q8h
:::::* Preferred regimen (2): [[Vancomycin]] {{and}} [[Cefepime]] 2 gm IV q12h
::::* 21.3.2 '''Methicillin-resistant Staphylococcus aureus (MRSA)''' unlikely
:::::* Preferred regimen (1): [[Nafcillin]]  {{and}} [[Ceftazidime]]
:::::* Preferred regimen (2): [[Oxacillin]] {{and}} [[Cefepime]]
:::* 21.4 '''Specific therapy'''
::::* 21.4.1 ''' Methicillin-susceptible Staphylococcus aureus (MSSA)'''
:::::* Preferred regimen (1): [[Nafcillin]]
:::::* Preferred regimen (2): [[Oxacillin]] 2 gm IV q4h
:::::* Preferred regimen (3): [[Cefazolin]] 2 gm IV q8h
:::::* Alternative regimen: [[Vancomycin]] 1 gm IV q12h (if over 100 kg, 1.5 gm IV q12h)
::::* 21.4.2 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
:::::* Preferred regimen: [[Vancomycin]] 1 gm IV q12h
:::::* Alternative regimen: [[Linezolid]] 600 mg q12h PO/IV with or without [[Rifampin]] 300 mg PO/IV bid
::* 22. '''Diabetic foot osteomyelitis'''
:::* High risk for MRSA
::::* Preferred regimen (1): [[Linezolid]] 600 mg IV or PO q12h
::::* Preferred regimen (2): [[Daptomycin]] 4 mg/kg IV q24h
::::* Preferred regimen (3): [[Vancomycin]] 15–20 mg/kg IV q8–12h (trough: 10–20 mg/L)
::* 23. ''' Necrotizing fasciitis'''<ref name="pmid24947530">{{cite journal| author=Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL et al.| title=Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America. | journal=Clin Infect Dis | year= 2014 | volume= 59 | issue= 2 | pages= 147-59 | pmid=24947530 | doi=10.1093/cid/ciu296 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24947530  }} </ref>
:::* 23.1 '''In adult'''
::::* Preferred regimen (1): [[Nafcillin]] 1–2 g IV  q4h (severe Pencillin allergy: [[Vancomycin]], [[linezolid]], [[quinupristin]]/[[dalfopristin]], daptomycin)
::::* Preferred regimen (2): [[Oxacillin]] 1–2 g IV  q4h
::::* Preferred regimen (3): [[Cefazolin]] 1 g IV  q8h
::::* Preferred regimen (4): [[Vancomycin]] 15 mg/kg IV bid
::::* Preferred regimen (5): [[Clindamycin]] 600–900 mg IV  q8h
:::* 23.2 '''In childern'''
::::* Preferred regimen (1): [[Nafcillin]] 50 mg/kg/dose IV  q6h  (severe Pencillin allergy: [[Vancomycin]], [[linezolid]], [[quinupristin]]/[[dalfopristin]], [[daptomycin]])
::::* Preferred regimen (2): [[Oxacillin]] 50 mg/kg/dose IV q6h
::::* Preferred regimen (3): [[Cefazolin]] 33 mg/kg/dose IV q8h
::::* Preferred regimen (4): [[Vancomycin]] 15 mg/kg/dose IV q6h
::::* Preferred regimen (5): [[Clindamycin]] 10–13 mg/kg/dose IV q8h  ([[Bacteriostatic]]; potential cross-resistance and emergence of resistance in [[erythromycin]]-resistant strains; inducible resistance in methicillin resistent staphylococcus aureus)
::* 24. '''Staphylococcal toxic shock syndrome'''<ref name="pmid19393958">{{cite journal| author=Lappin E, Ferguson AJ| title=Gram-positive toxic shock syndromes. | journal=Lancet Infect Dis | year= 2009 | volume= 9 | issue= 5 | pages= 281-90 | pmid=19393958 | doi=10.1016/S1473-3099(09)70066-0 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19393958  }} </ref>
:::* 24.1 '''Methicillin sensitive Staphylococcus aureus'''
::::* Preferred regimen (1): [[Cloxacillin]]  250-500 mg PO q6h (max dose: 4 g/24 hr)
::::* Preferred regimen (2): [[Nafcillin]]  4-12 g/24 hr IV q4-6hr (max dose: 12 g/24 hr)
::::* Preferred regimen (3): [[Cefazolin]] 0.5-2g IV/IM q8h (max dose: 12 g/24 hr) {{and}} [[Clindamycin]] 150-600 mg IV, IM/PO q6-8h  (max dose: 5 g/24 hr IV or IM or 2 g/24 hr PO)
::::* Alternative regimen (1): [[Clarithromycin]] 250-500 mg PO q12h (max dose: 1 g/24 hr) {{and}} [[Clindamycin]] 150-600 mg IV, IM/PO q6-8h  (max dose: 5 g/24 hr IV/IM or 2 g/24h PO)
::::* Alternative regimen (2): [[Rifampicin]] {{and}} [[Linezolid]] 600 mg IV/PO q12h
::::* Alternative regimen (3): [[Daptomycin]]
::::* Alternative regimen (4): [[Tigecycline]] 100 mg loading dose {{then}} 50 mg IV q12h
:::* 24.2 '''Methicillin resistant Staphylococcus  aureus'''
::::* Preferred regimen (1): [[Clindamycin]] 150-600 mg IV, IM/PO q6-8h (max dose: 5 g/24h IV/IM or 2 g/24h PO)
::::* Preferred regimen (2): [[Linezolid]] 600 mg IV/PO q12h {{and}} [[Vancomycin]] 15-20 mg/kg IV q8-12h, (max: 2 g per dose)
::::* Preferred regimen (3): [[Teicoplanin]]
::::* Alternative regimen (1): [[Rifampicin]] {{and}} [[Linezolid]] 600 mg IV/PO q12h
::::* Alternative regimen (2): [[Daptomycin]]
::::* Alternative regimen (3): [[Tigecycline]] 100 mg loading dose {{then}} 50 mg IV q12h
:::* 24.3 '''Glycopeptide resistant or intermediate Staphylococcus aureus'''
::::* Preferred regimen: [[Linezolid]] 600 mg IV/PO q12h {{and}} [[Clindamycin]] 150-600 mg IV, IM/PO q6-8h (max dose: 5 g/24 hr IV/IM or 2 g/24h PO) (if sensitive)
::::* Alternative regimen (1): [[Daptomycin]]
::::* Alternative regimen (2): [[Tigecycline]] 100 mg loading dose {{then}} 50 mg IV q12h


==References==
==References==

Revision as of 23:10, 7 August 2015

Staphylococcus aureus infection Main page

Overview

Classification

Pathophysiology

Causes

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Medical Therapy

Antimicrobial Regimen

  • 1. Infectious endocarditis[1]
  • 1.1 In adults
  • Preferred regimen (1): Vancomycin 15-20 mg/kg IV q8-12h
  • Preferred regimen (2): Daptomycin 6mg/kg/dose IV qd
  • 2. Intravascular catheter-related infections[2]
  • 2.1 Methicillin susceptible Staphylococcus aureus (MSSA)
  • Preferred regimen (1): Nafcillin 2 g IV q6h
  • Preferred regimen (2): Oxacillin 2 g IV q6h
  • Alternative regimen (1): Cefazolin 2 g IV q8h
  • Alternative regimen (2): Vancomycin 15 mg/kg IV q12h
  • 2.1.1 Pediatric dose of Nafcillin
  • 2.1.1.1 Neonates (< 4 weeks)
  • For < 1200 g: Nafcillin 50 mg/kg/day q12h
  • For ≤ 7 days of age and 1200–2000 g: Nafcillin 50 mg/kg/day q12h
  • For ≤ 7 days of age and > 2000 g: Nafcillin 75 mg/kg/day q8h
  • For > 7 days of age and 1200–2000 g: Nafcillin 75 mg/kg/day q8h
  • For > 7 days of age and > 2000 g: Nafcillin 100 mg/kg/day q6h
  • 2.1.1.2 Infants and children (> 4 weeks)
  • 2.1.2 Pediatric dose of Oxacillin
  • 2.1.2.1 Neonates (< 4 weeks)
  • For < 1200 g: Oxacillin 50 mg/kg/day q12h
  • For Postnatal age < 7 days and 1200–2000 g: Oxacillin 50–100 mg/kg/day q12h
  • For Postnatal age < 7 days and > 2000 g: Oxacillin 75–150 mg/kg/day q8h
  • For Postnatal age ≥ 7 days and 1200–2000 g: Oxacillin 75–150 mg/kg/day q8h
  • For Postnatal age ≥ 7 days and > 2000 g: Oxacillin 100–200 mg/kg/day q6h
  • 2.1.2.2 Infants and children(> 4weeks)
  • 2.1.3 Pediatric dose of Cefazolin
  • 2.1.3.1 Neonates (< 4 weeks)
  • Postnatal age ≤ 7 days: Cefazolin 40 mg/kg/day q12h
  • Postnatal age > 7 days and ≤ 2000 g: Cefazolin 40 mg/kg/day q12h
  • Postnatal age > 7 days and > 2000 g: Cefazolin 60 mg/kg/day q8h
  • 2.1.3.2 Infants and children (> 4 weeks)
  • 2.1.4 Pediatric dose of Vancomycin
  • 2.1.4.1 Neonates (< 4 weeks)
  • Postnatal age ≤ 7 days and < 1200 g: Vancomycin 15 mg/kg/day q24h.
  • Postnatal age ≤ 7 days and 1200–2000 g: Vancomycin 10–15 mg/kg q12–18h.
  • Postnatal age ≤ 7 days and > 2000 g: Vancomycin 10–15 mg/kg q8–12h.
  • Postnatal age > 7 days and < 1200 g: Vancomycin 15 mg/kg/day q24h.
  • Postnatal age > 7 days and 1200–2000 g: Vancomycin 10–15 mg/kg q8–12h.
  • Postnatal age > 7 days and > 2000 g: Vancomycin 15–20 mg/kg q8h.
  • 2.1.4.2 Infants and children (> 4 weeks)
  • 2.2 Methicillin resistant Staphylococcus aureus (MRSA)
  • 2.2.1 Pediatric dose of Linezolid
  • 2.2.1.1 Neonates (< 4 weeks)
  • For < 1200 g: Linezolid 10 mg/kg q8–12h (note: q12h in patients < 34 weeks gestation and < 1 week of age).
  • For < 7 days of age and ≥ 1200 g: Linezolid 10 mg/kg q8–12h (note: q12h in patients < 34 weeks gestation and < 1 week of age).
  • For ≥ 7 days and ≥ 1200 g: Linezolid 10 mg/kg q8h
  • 2.2.1.2 Infants and children < 12 years (> 4 weeks)
  • 2.2.1.3 Children ≥ 12 years and adolescents
  • 2.2.2 Pediatric dose of Gentamycin
  • 2.2.2.1 Neonates (< 4 weeks)
  • Premature neonates and < 1000 g: Gentamycin 3.5 mg/kg q24h
  • < 1200 g: Gentamycin 2.5 mg/kg q18-24h.
  • Postnatal age ≤ 7 days: Gentamycin 2.5 mg/kg q12h.
  • Postnatal age > 7 days and 1200–2000 g: Gentamycin 2.5 mg/kg q8-12h.
  • Postnatal age > 7 days and > 1200 g: Gentamycin 2.5 mg/kg q8h.
  • Premature neonates with normal renal function: Gentamycin 3.5–4 mg/kg q24h.
  • Term neonates with normal renal function: Gentamycin 3.5–5 mg/kg q24h.
  • 2.2.2.2 Infants and children < 5 years (> 4 weeks)
  • Gentamycin 2.5 mg/kg q8h; qd dosing in patients with normal renal function, Gentamycin 5–7.5 mg/kg q24h.
  • 2.2.2.3 Children ≥ 5 years
  • 2.2.3 Pediatric dose of Trimethoprim-Sulfamethoxazole
  • 2.2.3.1 Infants > 2 months of age and children of mild-to-moderate infections
  • 3. Cellulitis[3]
3.1 Purulent cellulitis (defined as cellulitis associated with purulent drainage or exudate in the absence of a drainable abscess)
  • 3.1.1 In adults
  • 3.1.2 In children
  • Preferred regimen (1): Clindamycin 10–13 mg/kg PO q6–8h, not to exceed 40 mg/kg/day
  • Preferred regimen (2): Trimethoprim 4–6 mg/kg, Sulfamethoxazole 20–30 mg/kg PO q12h
  • Preferred regimen (3)
  • 3.1 If patient body weight < 45kg then Doxycycline 2 mg/kg PO q12h
  • 3.2 If patient body weight 45kg then Doxycycline adult dose
  • Preferred regimen (4): Minocycline 4 mg/kg PO 200 mg as a single dose, THEN Minocycline 2 mg/kg PO q12h
  • Preferred regimen (5): Linezolid 10 mg/kg PO q8h, (max: 600 mg)
  • 3.2 Nonpurulent cellulitis (defined as cellulitis with no purulent drainage or exudate and no associated abscess)
  • 3.2.1 In adults
  • Preferred regimen (1): Beta-lactam (eg, Cephalexin and Dicloxacillin) 500 mg PO qid
  • Preferred regimen (2): Clindamycin 300–450 mg PO tid
  • Preferred regimen (3): Amoxicillin 500 PO mg tid
  • Preferred regimen (4): Linezolid 600 mg PO bid
  • Note (1): Empirical therapy for beta-hemolytic streptococci is recommended. Empirical coverage for CA-MRSA is recommended in patients who do not respond to beta-lactam therapy and may be considered in those with systemic toxicity.
  • Note (2): Provide coverage for both beta-hemolytic streptococci and CA-MRSA beta-lactam (eg, Amoxicillin) with or without Trimethoprim-Sulfamethoxazole or a Tetracycline
  • 3.2.2 In children
  • Preferred regimen (1): Clindamycin 10–13 mg/kg PO q6–8h, not to exceed 40 mg/kg/day
  • Preferred regimen (2): Trimethoprim 4–6 mg/kg, Sulfamethoxazole 20–30 mg/kg PO q12h
  • Preferred regimen (3): Linezolid 10 mg/kg PO q8h, not to exceed 600 mg
  • Note (1): Clindamycin causes Clostridium difficile–associated disease may occur more frequently, compared with other oral agents.
  • Note (2): Trimethoprim-Sulfamethoxazole not recommended for women in the third trimester of pregnancy and for children ,2 months of age.
  • Note (3): Tetracyclines are not recommended for children under 8 years of age and are pregnancy category D.
  • 4.1 Methicillin-resistant Staphylococcus aureus (MRSA)
  • 4.1.1 In adults
  • 4.1.2 In children
  • Preferred regimen (1): Vancomycin15 mg/kg/dose IV q6h
  • Preferred regimen (2): Linezolid 10 mg/kg/dose PO/IV q8h
  • Note: Consider the addition of Rifampin 600 mg qd OR 300–450 mg bid to Vancomycin.
  • 4.2 Methicillin-susceptible Staphylococcus aureus (MSSA)
  • Preferred regimen (1): Nafcillin 2 g IV q4h
  • Preferred regimen (2): Oxacillin 2 g IV q4h
  • Alternative regimen: Vancomycin 30–45 mg/kg/day IV q8–12h
  • 5. Cerebrospinal fluid shunt infection[7][8]
  • 5.1 Methicillin-resistant Staphylococcus aureus (MRSA)
  • Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h with or without Rifampin 600 mg IV or PO q24h
  • Note: Shunt removal is recommended, and it should not be replaced until cerebrospinal fluid cultures are repeatedly negative.
  • 5.2 Methicillin-susceptible Staphylococcus aureus (MSSA)
  • Preferred regimen (1): Nafcillin 2 g IV q4h with or without Rifampin 600 mg IV/PO q24h
  • Preferred regimen (2): Oxacillin 2 g IV q4h
  • 6.1 Penicillin-susceptible Staphylococcus aureus or Streptococcus
  • Preferred regimen: Penicillin G 4 MU IV q4h for 2–4 weeks, THEN PO to complete 6–8 weeks
  • 6.2 Methicillin-susceptible Staphylococcus aureus or Streptococcus
  • Preferred regimen (1): Cefazolin 2 g IV q8h for 2–4 weeks, THEN PO to complete 6–8 weeks
  • Preferred regimen (2): Nafcillin 2 g IV q4h for 2–4 weeks, THEN PO to complete 6–8 weeks
  • Preferred regimen (3): Oxacillin 2 g IV q4h for 2–4 weeks, THEN PO to complete 6–8 weeks
  • Alternative regimen: Clindamycin 600 mg IV q6h for 2–4 weeks, THEN PO to complete 6–8 weeks
  • 6.3 Methicillin-resistant Staphylococcus aureus (MRSA)
  • 6.3.1 In adults
  • Preferred regimen: Vancomycin loading dose 25–30 mg/kg IV THEN Vancomycin 15–20 mg/kg IV q8–12h for 2–4 weeks, THEN PO to complete 6–8 weeks
  • Alternative regimen (1): Linezolid 600 mg PO/IV q12h for 4–6 weeks
  • Alternative regimen (2): Trimethoprim-Sulfamethoxazole 5 mg/kg PO/IV q8–12h for 4–6 weeks
  • 6.3.2 Pediatric dose
  • Preferred regimen (1): Vancomycin 15 mg/kg IV q6h
  • Preferred regimen (2): Linezolid 10 mg/kg PO/IV q8h
  • Note: Consider the addition of Rifampin 600 mg qd or 300–450 mg bid to Vancomycin in adult patients..
  • 7. Bacterial meningitis
  • 7.1 Methicillin susceptible Staphylococcus aureus (MSSA)
  • Preferred regimen (1): Nafcillin 9–12 g/day IV q4h
  • Preferred regimen (2): Oxacillin 9–12 g/day IV q4h
  • Alternative regimen (1): Vancomycin 30–45 mg/kg/day IV q8–12h
  • Alternative regimen (2): Meropenem 6 g/day IV q8h
  • 7.2 Methicillin resistant Staphylococcus aureus (MRSA)
  • 8. Septic thrombosis of cavernous or dural venous sinus[13]
  • 8.1 Methicillin-resistant Staphylococcus aureus (MRSA)
  • 8.1.1 In adults
  • 8.1.2 Pediatric dose
  • Preferred regimen (1): Vancomycin 15 mg/kg IV q6h
  • Preferred regimen (2): Linezolid 10 mg/kg PO/IV q8h
  • Note (1): Surgical evaluation for incision and drainage of contiguous sites of infection or abscess is recommended whenever possible.
  • Note (2): Consider the addition of Rifampin 600 mg qd or 300–450 mg bid to Vancomycin.
  • 9. Subdural empyema
  • 9.1 Methicillin-resistant Staphylococcus aureus (MRSA)[14]
  • 9.1.1 In adults
  • 9.1.2 In children
  • Preferred regimen (1): Vancomycin 15 mg/kg IV q6h
  • Preferred regimen (2): Linezolid 10 mg/kg PO/IV q8h
  • Note: Consider the addition of Rifampin 600 mg qd or 300–450 mg bid to Vancomycin.
  • 10. Acute conjunctivitis[15]
  • 10.1 Methicillin-resistant Staphylococcus aureus (MRSA)
  • 11. Appendicitis
  • 11.1 Health care–associated complicated intra-abdominal infection[16]
  • 11.1.1 Methicillin-resistant Staphylococcus aureus (MRSA)
  • Preferred regimen: Vancomycin 15–20 mg/kg IV q8–12h
  • 12. Diverticulitis
  • 12.1 Health care–associated complicated intra-abdominal infection[16]
  • 12.1.1 Methicillin-resistant Staphylococcus aureus (MRSA)
  • Preferred regimen: Vancomycin 15–20 mg/kg IV q8–12h.
  • 13. Peritonitis secondary to bowel perforation, peritonitis secondary to ruptured appendix, peritonitis secondary to ruptured appendix, typhlitis
  • 13.1 Health care–associated complicated intra-abdominal infection[16]
  • 13.1.1 Methicillin-resistant Staphylococcus aureus (MRSA)
  • Preferred regimen: Vancomycin 15–20 mg/kg IV q8–12h
  • 14. Cystic fibrosis[17]
  • 14.1 Adults
  • 14.1.1 If methicillin sensitive staphylococcus aureus
  • 14.1.2 If methicillin resistant staphylococcus aureus
  • Preferred Regimen (1): Vancomycin 15-20 mg/kg IV q8-12h
  • Preferred Regimen (2): Linezolid 600 mg PO/IV q12h
  • 14.2 Pediatric
  • 14.2.1 If methicillin sensitive staphylococcus aureus
  • Preferred Regimen (1): Nafcillin 5 mg/kg q6h (Age >28 days)
  • Preferred Regimen (2): Oxacillin 75 mg/kg q6h (Age >28 days)
  • 14.2.2 If methicillin resistant staphylococcus aureus
  • Preferred Regimen (1): Vancomycin 40 mg/kg q6-8h (Age >28 days)
  • Preferred Regimen (2): Linezolid 10 mg/kg PO/IV q8h (up to age 12)
  • 15. Bronchiectasis[18]
  • 15.1 In adults
  • 15.1.1 Recommended first-line treatment and length of treatment
  • 15.1.1.1 Methicillin-susceptible Staphylococcus aureus (MSSA)
  • 15.1.1.2 Methicillin-resistant Staphylococcus aureus (MRSA)
  • Patient's body weight is < 50 kg
  • Patient's body weight is > 50 kg
  • 15.1.1.3 Methicillin-resistant Staphylococcus aureus (MRSA)
  • Preferred regimen (1): Vancomycin 1 g IV bd (monitor serum levels and adjust dose accordingly)
  • Preferred regimen (2): Teicoplanin 400 mg qd for 14 days
  • 15.1.2 Recommended second-line treatment and length of treatment
  • 15.1.2.1 Methicillin-susceptible Staphylococcus aureus (MSSA)
  • 15.1.2.2 Methicillin-resistant Staphylococcus aureus (MRSA)
  • Patient's body weight is < 50 kg
  • Patient's body weight is > 50 kg
  • 15.1.2.3 Methicillin-resistant Staphylococcus aureus (MRSA)
  • Preferred regimen: Linezolid 600 mg IV bd for 14 days
  • 15.2 In children
  • 15.2.1 Recommended first-line treatment and length of treatment
  • 15.2.1.1 Methicillin-susceptible Staphylococcus aureus (MSSA)
  • 15.2.1.2 Methicillin-resistant Staphylococcus aureus (MRSA)
  • 15.2.1.2.1 Children (< 12 yr)
  • 15.2.1.2.2 Children (> 12 yr)
  • 15.2.1.3 Methicillin-resistant Staphylococcus aureus (MRSA)
  • Preferred regimen (1): Vancomycin 45-60 mg/kg/day IV q8-12h
  • Preferred regimen (2): Teicoplanin 400 mg qd for 14 days
  • 15.2.2 Recommended second-line treatment and length of treatment
  • 15.2.2.1 Methicillin-susceptible Staphylococcus aureus (MSSA)
  • 15.2.2.2 Methicillin-resistant Staphylococcus aureus (MRSA)
  • 15.2.2.3 Methicillin-resistant Staphylococcus aureus (MRSA)
  • Preferred regimen: Linezolid 10 mg/kg PO/IV q12h
  • 15.3 Long-term oral antibiotic treatment
  • 15.3.1 In adults
  • 15.3.1.1 Recommended first-line treatment and length of treatment
  • 15.3.1.1.1 Methicillin-susceptible Staphylococcus aureus (MSSA)
  • 15.3.1.2 Recommended second-line treatment and length of treatment
  • 15.3.1.2.1 Methicillin-susceptible Staphylococcus aureus (MSSA)
  • Preferred regimen (1): Nafcillin 2 gm IV q4h
  • Preferred regimen (2): oxacillin 2 gm IV q4h (if MSSA)
  • Alternative regimen (1): Vancomycin 1 gm IV q12h
  • Alternative regimen (2): Linezolid 600 mg PO bid (if MRSA)
  • 17. Community-acquired pneumonia[20]
  • 17.1 Methicillin-susceptible Staphylococcus aureus (MSSA)
  • 17.2 Methicillin-resistant Staphylococcus aureus (MRSA)
  • Preferred Regimen (1): Vancomycin 45-60 mg/kg/day q8-12h (max: 2000 mg/dose) for 7-21 days
  • Preferred Regimen (2): Linezolid 600 mg PO/IV q12h for 10-14 days
  • Alternative Regimen: Trimethoprim-Sulfamethoxazole 1-2 double-strength tablets (800/160 mg) q12-24h
  • 18. Olecranon bursitis or prepatellar bursitis
  • 18.1 Methicillin-susceptible Staphylococcus aureus (MSSA)
  • 18.2 Methicillin-resistant Staphylococcus aureus (MRSA)
  • Preferred regimen (1): Vancomycin 1 g IV q12h
  • Preferred regimen (2): Linezolid 600 mg PO qd
  • Note: Initially aspirate q24h and treat for a minimum of 2–3 weeks.
  • 19. Septic arthritis
  • 19.1 In adults
  • 19.1.1 Methicillin-resistant Staphylococcus aureus (MRSA)
  • Preferred regimen: Vancomycin 15–20 mg/kg IV q8–12h
  • Alternative regimen (1): Daptomycin 6 mg/kg IV q24h in adults
  • Alternative regimen (2): Linezolid 600 mg PO/IV q12h
  • Alternative regimen (3): Clindamycin 600 mg PO/IV q8h
  • Alternative regimen (4): TMP-SMX 3.5–4.0 mg/kg PO/IV q8–12h
  • 19.2.1 Methicillin-susceptible Staphylococcus aureus (MSSA)
  • Preferred regimen (1): Nafcillin 2 g IV q6h
  • Preferred regimen (2): Clindamycin 900 mg IV q8h
  • Alternative regimen (1): Cefazolin 0.25–1 g IV/IM q6–8h
  • Alternative regimen (2): Vancomycin 500 mg IV q6h or 1 g IV q12h
  • 19.2 In childern
  • Preferred regimen (1): Vancomycin 15 mg/kg IV q6h
  • Preferred regimen (2): Daptomycin 6–10 mg/kg IV q24h
  • Preferred regimen (3): Linezolid 10 mg/kg PO/IV q8h
  • Preferred regimen (4): Clindamycin 10–13 mg/kg PO/IV q6–8h
  • 20. Septic arthritis, prosthetic joint infection (device-related osteoarticular infections)
  • 20.1 Methicillin-susceptible Staphylococcus aureus (MSSA)
  • Preferred regimen (1): Nafcillin 2 g IV q4–6h
  • Preferred regimen (2): Oxacillin 2 g IV q4–6h
  • Alternative regimen (1): Cefazolin 1–2 g IV q8h
  • Alternative regimen (2): Ceftriaxone 2 g IV q24h
  • Alternative regimen (if allergic to penicillins) (3): Clindamycin 900 mg IV q8h
  • Alternative regimen (if allergic to penicillins) (4): Vancomycin 15–20 mg/kg IV q8–12h, (max: 2 g per dose)
  • 20.2 Methicillin-resistant Staphylococcus aureus (MRSA)
  • Early-onset (2 months after surgery) or acute hematogenous prosthetic joint infections involving a stable implant with short duration (< 3 weeks) of symptoms and debridement (but device retention)
  • Preferred regimen: Vancomycin AND Rifampin 600 mg PO qd or 300–450 mg PO bid for 2 weeks
  • Alternative regimen (1): Daptomycin 6 mg/kg IV q24h AND Rifampin 600 mg PO qd or 300–450 mg PO bid for 2 weeks
  • Alternative regimen (2): Linezolid 600 IV q8h AND Rifampin 600 mg PO qd or 300–450 mg PO bid for 2 weeks
  • Note: The above regimen should be followed by Rifampin and a Fluoroquinolone, TMP/SMX, a Tetracycline or Clindamycin for 3-6 months for hips and knees, respectively.
  • 21. Hematogenous osteomyelitis
  • 21.1 Adult (> 21 yrs)
  • 21.1.1 Methicillin-resistant Staphylococcus aureus (MRSA) possible
  • Preferred regimen: Vancomycin 1 gm IV q12h (if over 100 kg, 1.5 gm IV q12h)
  • 21.1.2 Methicillin-resistant Staphylococcus aureus (MRSA) unlikely
  • 21.2 Children (> 4 months)-Adult
  • 21.2.1 Methicillin-resistant Staphylococcus aureus (MRSA) possible
  • 21.2.2 Methicillin-resistant Staphylococcus aureus (MRSA) unlikely
  • Preferred regimen (1): Nafcillin
  • Preferred regimen (2): Oxacillin q6h (max. 8–12 gm per day)
  • Note: Add Ceftazidime 50 mg q8h or Cefepime 150 mg q8h if Gram negative bacilli on Gram stain
  • 21.3 Newborn (< 4 months.)
  • 21.3.1 Methicillin-resistant Staphylococcus aureus (MRSA) possible
  • 21.3.2 Methicillin-resistant Staphylococcus aureus (MRSA) unlikely
  • 21.4 Specific therapy
  • 21.4.1 Methicillin-susceptible Staphylococcus aureus (MSSA)
  • Preferred regimen (1): Nafcillin
  • Preferred regimen (2): Oxacillin 2 gm IV q4h
  • Preferred regimen (3): Cefazolin 2 gm IV q8h
  • Alternative regimen: Vancomycin 1 gm IV q12h (if over 100 kg, 1.5 gm IV q12h)
  • 21.4.2 Methicillin-resistant Staphylococcus aureus (MRSA)
  • 22. Diabetic foot osteomyelitis
  • High risk for MRSA
  • Preferred regimen (1): Linezolid 600 mg IV or PO q12h
  • Preferred regimen (2): Daptomycin 4 mg/kg IV q24h
  • Preferred regimen (3): Vancomycin 15–20 mg/kg IV q8–12h (trough: 10–20 mg/L)
  • 23. Necrotizing fasciitis[21]
  • 23.1 In adult
  • 23.2 In childern
  • 24. Staphylococcal toxic shock syndrome[22]
  • 24.1 Methicillin sensitive Staphylococcus aureus
  • Preferred regimen (1): Cloxacillin 250-500 mg PO q6h (max dose: 4 g/24 hr)
  • Preferred regimen (2): Nafcillin 4-12 g/24 hr IV q4-6hr (max dose: 12 g/24 hr)
  • Preferred regimen (3): Cefazolin 0.5-2g IV/IM q8h (max dose: 12 g/24 hr) AND Clindamycin 150-600 mg IV, IM/PO q6-8h (max dose: 5 g/24 hr IV or IM or 2 g/24 hr PO)
  • Alternative regimen (1): Clarithromycin 250-500 mg PO q12h (max dose: 1 g/24 hr) AND Clindamycin 150-600 mg IV, IM/PO q6-8h (max dose: 5 g/24 hr IV/IM or 2 g/24h PO)
  • Alternative regimen (2): Rifampicin AND Linezolid 600 mg IV/PO q12h
  • Alternative regimen (3): Daptomycin
  • Alternative regimen (4): Tigecycline 100 mg loading dose THEN 50 mg IV q12h
  • 24.2 Methicillin resistant Staphylococcus aureus
  • Preferred regimen (1): Clindamycin 150-600 mg IV, IM/PO q6-8h (max dose: 5 g/24h IV/IM or 2 g/24h PO)
  • Preferred regimen (2): Linezolid 600 mg IV/PO q12h AND Vancomycin 15-20 mg/kg IV q8-12h, (max: 2 g per dose)
  • Preferred regimen (3): Teicoplanin
  • Alternative regimen (1): Rifampicin AND Linezolid 600 mg IV/PO q12h
  • Alternative regimen (2): Daptomycin
  • Alternative regimen (3): Tigecycline 100 mg loading dose THEN 50 mg IV q12h
  • 24.3 Glycopeptide resistant or intermediate Staphylococcus aureus
  • Preferred regimen: Linezolid 600 mg IV/PO q12h AND Clindamycin 150-600 mg IV, IM/PO q6-8h (max dose: 5 g/24 hr IV/IM or 2 g/24h PO) (if sensitive)
  • Alternative regimen (1): Daptomycin
  • Alternative regimen (2): Tigecycline 100 mg loading dose THEN 50 mg IV q12h

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