Hospital-acquired pneumonia medical therapy
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Editor(s)-in-Chief: C. Michael Gibson, M.S., M.D. [1] Phone:617-632-7753; Philip Marcus, M.D., M.P.H.[2]
Overview
Antimicrobial therapy
Patients prone to Methicillin-resistant staphylococcus aureus
- Critically ill patients
- History of recent antibiotic therapy
- Patient admitted in a hospital with increased incidence of MRSA.
Antibiotic choice for MRSA
- Vancomycin
- Linezolid
- Teicoplanin
- In case no MRSA is isolated on culture these antibiotics should be discontinued.
Side-effects of Linezolid
- Thrombocytopenia
- Gastrointestinal side-effects
- Renal dysfunction
Side-effects of vancomycin
- Renal toxicity were more common in vancomycin compared to linezolid
Vancomycin trough
- The target vancomycin trough concentrations is 15 to 20 mcg/mL [1].
Supportive trial data [2]
In a study done in 1184 patients treated with linezolid and vancomycin no significant difference in 60 days mortality were found between the two groups. The side-effects profile were similar in both the groups however nephrotoxicity was commoner in the vancomycin group. Linezolid was found to be non-inferior to vancomycin for clinical outcome, and microbiologic outcome at end of treatment and end of study.
References
- ↑ "Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia". American Journal of Respiratory and Critical Care Medicine. 171 (4): 388–416. 2005. doi:10.1164/rccm.200405-644ST. PMID 15699079. Retrieved 2012-09-11. Unknown parameter
|month=ignored (help) - ↑ Wunderink RG, Niederman MS, Kollef MH, Shorr AF, Kunkel MJ, Baruch A, McGee WT, Reisman A, Chastre J (2012). "Linezolid in methicillin-resistant Staphylococcus aureus nosocomial pneumonia: a randomized, controlled study". Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 54 (5): 621–9. doi:10.1093/cid/cir895. PMID 22247123. Retrieved 2012-09-11. Unknown parameter
|month=ignored (help)