Table 3.

Antibiotics relevant in the treatment of MRSA

AGENTROUTEACTIVITYDOSAGE FOR MRSA INFECTIONSCOMMENTS
Lincosamides
  • ClindamycinOral or IVBacteriostatic300‑450 mg orally 4 times daily or 600‑900 mg IV every 8 hIncreasing resistance among community-associated MRSA and methicillin-sensitive Staphylococcus aureus; inducible resistance in MRSA
Sulfonamides
  • Trimethoprim-sulfamethoxazoleOralBactericidal1–2 double-strength tablets (160 mg and 800 mg) orally twice dailyContraindicated in severe renal or hepatic dysfunction; multiple drug interactions (including ACEIs and ARBs)
Tetracyclines
  • TetracyclineOralBacteriostatic250–500 mg orally 4 times dailyCaution about teratogenicity
  • DoxycyclineOralBacteriostatic100 mg orally twice dailyCaution about teratogenicity
  • MinocyclineOralBacteriostatic100 mg orally twice dailyCaution about teratogenicity
  • TigecyclineIVBacteriostatic100-mg IV loading dose, then 50 mg IV every 12 hCaution about teratogenicity; indicated for SSTI and intra-abdominal infections (unfavourable outcomes in community-associated pneumonia)
Oxazolidinones
  • LinezolidOral or IVBacteriostatic600 mg orally twice daily or 600 mg IV every 12 hIndicated for SSTI; multiple drug interactions, risk of myelosuppression if used 2 wk or longer; high cost
Lipopeptides
  • DaptomycinIVBactericidal4 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 hIndicated for SSTI, endocarditis, and bloodstream infection; not indicated for pneumonia unless from hematogenous origin; might cause eosinophilic pneumonia, abnormal coagulation, myopathy, and rhabdomyolysis
Lipoglycopeptides
  • VancomycinIVBactericidal15–20 mg/kg per dose every 8–12 h; consider loading dose of 25–30 mg/kg in seriously ill patientsDose monitoring; target levels vary with site and severity of infection
  •TelavancinIVBactericidal10 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.