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]

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 of 15 to 20 mcg/mL.

Supportive trial data

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.