Chapter 129. Staphylococcal Infections (Part 11)

Table 129-3 Antimicrobial Therapy for Serious Staphylococcal InfectionsaSensitivity/Resis tance of IsolateDrug of Choice s)Alternative(CommentsSensitive penicillintoPenicilliNafcillin (2Fewerthann G (4 mU q4h) g q4h) or oxacillin 5% of isolates are (2 g q4h), cefazolin sensitive (2 g q8h), penicillin. tovancomycin (1 g q12hb)SensitivetoNafcillinCefazolin (2Patients withmethicillinor oxacillin (2 g g q4h)q8hb), penicillinallergyvancomycin (1 g can be treated with q12hb) a cephalosporin if the allergy does not involve anaphylactic accelerated reaction; vancomycin is the alternative. Desensitization to an orβ-lactams may be indicated in selected cases of serious whereinfection maximalbactericidal activity is needed (e.g.,prosthetic-valve endocarditisc). Type A β-lactamase mayrapidly cefazolinhydrolyze andreduce its efficacy in...
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Chapter 129. Staphylococcal Infections (Part 11) Chapter 129. Staphylococcal Infections (Part 11) Table 129-3 Antimicrobial Therapy for Serious StaphylococcalInfectionsa Sensitivity/Resis Drug of Alternative( Commentstance of Isolate Choice s) Sensitive to Penicilli Nafcillin (2 Fewer thanpenicillin n G (4 mU q4h) g q4h) or oxacillin 5% of isolates are (2 g q4h), cefazolin sensitive to (2 g q8h), penicillin. vancomycin (1 g q12hb) Sensitive to Nafcillin Cefazolin (2 Patients withmethicillin or oxacillin (2 g g q8hb), penicillin allergy q4h) vancomycin (1 g can be treated with q12hb) a cephalosporin if the allergy does not involve an anaphylactic or accelerated reaction; vancomycin is the alternative. Desensitization to β-lactams may be indicated in selected cases of serious infection where maximal bactericidal activity is needed (e.g., prosthetic-valve endocarditisc). Type A β-lactamase may rapidly hydrolyze cefazolin and reduce its efficacy in endocarditis. Resistant to Vancom TMP-SMX Sensitivitymethicillin ycin (1 g q12hb) (TMP, 5 mg/kg testing is necessary q12hb), before an alternative minocycline or drug is used. doxycycline(100 Adjunctive drugs mg PO q12hb), (those that should ciprofloxacin (400 be used only in mg q12hb), combination with levofloxacin (500 other antimicrobial mg q24hb), agents) include quinupristin/dalfopr gentamicin (1 istin (7.5 mg/kg mg/kg q8hb), q8h), linezolid (600 rifampin (300 mg mg q12h except: PO q8h), and 400 mg q12h for fusidic acid (500uncomplicated skin mg q8h; not readilyinfections); available in thedaptomycin (4–6 United States).mg/kg q24hb, c) for Quinupristin/dalfoprbacteremia, istin is bactericidalendocarditis, and against methicillin-complicated skin resistant isolatesinfections; unless the strain istigecycline (100 mg resistant toIV once, then 50 erythromycin ormg q12h) for skin clindamycin. Theand soft tissue newer quinolonesinfections; may retain in vitroinvestigational activity againstdrugs: oritavancin, ciprofloxacin-dalbavancin, resistant isolates;telavancin resistance may develop during therapy. The efficacy of adjunctive therapy ...