AGENT | ROUTE | ACTIVITY | DOSAGE FOR MRSA INFECTIONS | COMMENTS |
---|---|---|---|---|
Lincosamides | ||||
• Clindamycin | Oral or IV | Bacteriostatic | 300‑450 mg orally 4 times daily or 600‑900 mg IV every 8 h | Increasing resistance among community-associated MRSA and methicillin-sensitive Staphylococcus aureus; inducible resistance in MRSA |
Sulfonamides | ||||
• Trimethoprim-sulfamethoxazole | Oral | Bactericidal | 1–2 double-strength tablets (160 mg and 800 mg) orally twice daily | Contraindicated in severe renal or hepatic dysfunction; multiple drug interactions (including ACEIs and ARBs) |
Tetracyclines | ||||
• Tetracycline | Oral | Bacteriostatic | 250–500 mg orally 4 times daily | Caution about teratogenicity |
• Doxycycline | Oral | Bacteriostatic | 100 mg orally twice daily | Caution about teratogenicity |
• Minocycline | Oral | Bacteriostatic | 100 mg orally twice daily | Caution about teratogenicity |
• Tigecycline | IV | Bacteriostatic | 100-mg IV loading dose, then 50 mg IV every 12 h | Caution about teratogenicity; indicated for SSTI and intra-abdominal infections (unfavourable outcomes in community-associated pneumonia) |
Oxazolidinones | ||||
• Linezolid | Oral or IV | Bacteriostatic | 600 mg orally twice daily or 600 mg IV every 12 h | Indicated for SSTI; multiple drug interactions, risk of myelosuppression if used 2 wk or longer; high cost |
Lipopeptides | ||||
• Daptomycin | IV | Bactericidal | 4 mg/kg IV every 24 h for SSTI; 6 mg/kg IV every 24 h for bacteremia or right-sided endocarditis, up to 12 mg/kg IV every 24 h | Indicated for SSTI, endocarditis, and bloodstream infection; not indicated for pneumonia unless from hematogenous origin; might cause eosinophilic pneumonia, abnormal coagulation, myopathy, and rhabdomyolysis |
Lipoglycopeptides | ||||
• Vancomycin | IV | Bactericidal | 15–20 mg/kg per dose every 8–12 h; consider loading dose of 25–30 mg/kg in seriously ill patients | Dose monitoring; target levels vary with site and severity of infection |
•Telavancin | IV | Bactericidal | 10 mg/kg IV every 24 h (if creatinine clearance > 50 mL/min) | Indicated for SSTI; increased mortality observed in chronic kidney disease |
ACEI—angiotensin-converting enzyme inhibitor, ARB—angiotensin receptor blocker, IV—intravenous, MRSA—methicillin-resistant Staphylococcus aureus, SSTI—skin and soft tissue infection.