Staphylococcus aureus infection medical therapy: Difference between revisions

	Staphylococcus aureus infection Main page
Overview
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Pathophysiology
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Latest revision as of 13:40, 20 August 2015

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Antimicrobial therapy is the mainstay of therapy for infections caused by Staphylococcus aureus. Staphylcoccus aureus has developed resistance to numerous commonly used antibiotics. The preferred antimicrobial agents for infections caused by methicillin-resistant Staphylococcus aureus (MRSA) include Vancomycin and non beta-lactam antibiotics such as Clindamycin and TMP-SMX.

Medical Therapy

Antibiotic resistance

Staph infection that is not antibiotic resistant can be treated in about a month (depending on severity) using antibiotics.

Antibiotic resistance in S. aureus was almost unknown when penicillin was first introduced in 1943; indeed, the original petri dish on which Alexander Fleming observed the antibacterial activity of the penicillium mould was growing a culture of S. aureus. By 1950, 40% of hospital S. aureus isolates were penicillin resistant; and by 1960, this had risen to 80%.^[1]

Mechanisms of antibiotic resistance

Staphylococcal resistance to Penicillin is mediated by penicillinase (a form of β-lactamase) production: an enzyme which breaks down the β-lactam ring of the penicillin molecule. Penicillinase-resistant penicillins such as Methicillin, Oxacillin, Cloxacillin, Dicloxacillin and Flucloxacillin are able to resist degradation by staphylococcal penicillinase.

The mechanism of resistance to methicillin is by the acquisition of the mecA gene, which codes for an altered penicillin-binding protein (PBP) that has a lower affinity for binding β-lactams (Penicillins, Cephalosporins and carbapenems). This confers resistance to all β-lactam antibiotics and obviates their clinical use during MRSA infections.

Glycopeptide resistance is mediated by acquisition of the vanA gene. The vanA gene originates from the enterococci and codes for an enzyme that produces an alternative peptidoglycan to which Vancomycin will not bind.

Today, S. aureus has become resistant to many commonly used antibiotics. In the UK, only 2% of all S. aureus isolates are sensitive to penicillin with a similar picture in the rest of the world, due to a penicillinase (a form of β-lactamase). The β-lactamase-resistant penicillins (Methicillin, Oxacillin, Cloxacillin and Flucloxacillin) were developed to treat penicillin-resistant S. aureus and are still used as first-line treatment. Methicillin was the first antibiotic in this class to be used (it was introduced in 1959), but only two years later, the first case of methicillin-resistant S. aureus (MRSA) was reported in England.^[2]

Despite this, MRSA generally remained an uncommon finding even in hospital settings until the 1990s when there was an explosion in MRSA prevalence in hospitals where it is now endemic.^[3]

MRSA infections in both the hospital and community setting are commonly treated with non-β-lactam antibiotics such as Clindamycin (a lincosamine) and Co-trimoxazole (also commonly known as trimethoprim/sulfamethoxazole). Resistance to these antibiotics has also led to the use of new, broad-spectrum anti-Gram positive antibiotics such as Linezolid because of its availability as an oral drug. First-line treatment for serious invasive infections due to MRSA is currently glycopeptide antibiotics (Vancomycin and Teicoplanin). There are number of problems with these antibiotics, mainly centered around the need for intravenous administration (there is no oral preparation available), toxicity and the need to monitor drug levels regularly by means of blood tests. There are also concerns that glycopeptide antibiotics do not penetrate very well into infected tissues (this is a particular concern with infections of the brain and meninges and in endocarditis). Glycopeptides must not be used to treat methicillin-sensitive S. aureus as outcomes are inferior.^[4]

Because of the high level of resistance to penicillins, and because of the potential for MRSA to develop resistance to Vancomycin, the Centers for Disease Control and Prevention have published guidelinesfor the appropriate use of Vancomycin. In situations where the incidence of MRSA infections is known to be high, the attending physician may choose to use a glycopeptide antibiotic until the identity of the infecting organism is known. When the infection is confirmed to be due to a methicillin-susceptible strain of S. aureus, then treatment can be changed to Flucloxacillin or even Penicillin as appropriate.

Vancomycin-resistant S. aureus (VRSA) is a strain of S. aureus that has become resistant to the glycopeptides. The first case of vancomycin-intermediate S. aureus (VISA) was reported in Japan in 1996;^[5] but the first case of S. aureus truly resistant to glycopeptide antibiotics was only reported in 2002.^[6] Three cases of VRSA infection have been reported in the United States as of 2005.^[7]

Antimicrobial Regimen

Staphylococcus aureus treatment

1. Infectious endocarditis^[8]

1.1 In adults

Preferred regimen (1): Vancomycin 15-20 mg/kg IV q8-12h
Preferred regimen (2): Daptomycin 6mg/kg/dose IV qd

2. Intravascular catheter-related infections^[9]

2.1 Methicillin susceptible Staphylococcus aureus (MSSA)

Preferred regimen (1): Nafcillin 2 g IV q6h
Preferred regimen (2): Oxacillin 2 g IV q6h
Alternative regimen (1): Cefazolin 2 g IV q8h
Alternative regimen (2): Vancomycin 15 mg/kg IV q12h

2.1.1 Pediatric dose of Nafcillin

2.1.1.1 Neonates (< 4 weeks)

For < 1200 g: Nafcillin 50 mg/kg/day q12h
For ≤ 7 days of age and 1200–2000 g: Nafcillin 50 mg/kg/day q12h
For ≤ 7 days of age and > 2000 g: Nafcillin 75 mg/kg/day q8h
For > 7 days of age and 1200–2000 g: Nafcillin 75 mg/kg/day q8h
For > 7 days of age and > 2000 g: Nafcillin 100 mg/kg/day q6h

2.1.1.2 Infants and children (> 4 weeks)

Nafcillin 100–200 mg/kg/day q4–6h

2.1.2 Pediatric dose of Oxacillin

2.1.2.1 Neonates (< 4 weeks)

For < 1200 g: Oxacillin 50 mg/kg/day q12h
For Postnatal age < 7 days and 1200–2000 g: Oxacillin 50–100 mg/kg/day q12h
For Postnatal age < 7 days and > 2000 g: Oxacillin 75–150 mg/kg/day q8h
For Postnatal age ≥ 7 days and 1200–2000 g: Oxacillin 75–150 mg/kg/day q8h
For Postnatal age ≥ 7 days and > 2000 g: Oxacillin 100–200 mg/kg/day q6h

2.1.2.2 Infants and children(> 4weeks)

Oxacillin 150–200 mg/kg/day q4–6h

2.1.3 Pediatric dose of Cefazolin

2.1.3.1 Neonates (< 4 weeks)

Postnatal age ≤ 7 days: Cefazolin 40 mg/kg/day q12h
Postnatal age > 7 days and ≤ 2000 g: Cefazolin 40 mg/kg/day q12h

Postnatal age > 7 days and > 2000 g: Cefazolin 60 mg/kg/day q8h

2.1.3.2 Infants and children (> 4 weeks)

Cefazolin 50 mg/kg/day q8h.

2.1.4 Pediatric dose of Vancomycin

2.1.4.1 Neonates (< 4 weeks)

Postnatal age ≤ 7 days and < 1200 g: Vancomycin 15 mg/kg/day q24h.
Postnatal age ≤ 7 days and 1200–2000 g: Vancomycin 10–15 mg/kg q12–18h.
Postnatal age ≤ 7 days and > 2000 g: Vancomycin 10–15 mg/kg q8–12h.
Postnatal age > 7 days and < 1200 g: Vancomycin 15 mg/kg/day q24h.
Postnatal age > 7 days and 1200–2000 g: Vancomycin 10–15 mg/kg q8–12h.
Postnatal age > 7 days and > 2000 g: Vancomycin 15–20 mg/kg q8h.

2.1.4.2 Infants and children (> 4 weeks)

Vancomycin 40 mg/kg/day q6–8h.

2.2 Methicillin resistant Staphylococcus aureus (MRSA)

Preferred regimen (1): Vancomycin 15 mg/kg IV q12h
Preferred regimen (2): Daptomycin 6–8 mg/kg/day IV
Preferred regimen (3): Linezolid 10 mg/kg IV/PO q12h
Preferred regimen (4): Vancomycin 15 mg/kg IV q12h AND (Rifampicin IV or Gentamycin IV)
Preferred regimen (5): Trimethoprim-Sulfamethoxazole 6–12 mg TMP/kg/day q12h alone (if susceptible)

2.2.1 Pediatric dose of Linezolid

2.2.1.1 Neonates (< 4 weeks)

For < 1200 g: Linezolid 10 mg/kg q8–12h (note: q12h in patients < 34 weeks gestation and < 1 week of age).
For < 7 days of age and ≥ 1200 g: Linezolid 10 mg/kg q8–12h (note: q12h in patients < 34 weeks gestation and < 1 week of age).
For ≥ 7 days and ≥ 1200 g: Linezolid 10 mg/kg q8h

2.2.1.2 Infants and children < 12 years (> 4 weeks)

Linezolid 10 mg/kg q8h

2.2.1.3 Children ≥ 12 years and adolescents

Linezolid 10 mg/kg q12h

2.2.2 Pediatric dose of Gentamycin

2.2.2.1 Neonates (< 4 weeks)

Premature neonates and < 1000 g: Gentamycin 3.5 mg/kg q24h
< 1200 g: Gentamycin 2.5 mg/kg q18-24h.
Postnatal age ≤ 7 days: Gentamycin 2.5 mg/kg q12h.
Postnatal age > 7 days and 1200–2000 g: Gentamycin 2.5 mg/kg q8-12h.
Postnatal age > 7 days and > 1200 g: Gentamycin 2.5 mg/kg q8h.
Premature neonates with normal renal function: Gentamycin 3.5–4 mg/kg q24h.
Term neonates with normal renal function: Gentamycin 3.5–5 mg/kg q24h.

2.2.2.2 Infants and children < 5 years (> 4 weeks)

Gentamycin 2.5 mg/kg q8h; qd dosing in patients with normal renal function, Gentamycin 5–7.5 mg/kg q24h.

2.2.2.3 Children ≥ 5 years

Gentamycin 2–2.5 mg/kg q8h; qd with normal renal function, Gentamycin 5–7.5 mg/kg q24h.

2.2.3 Pediatric dose of Trimethoprim-Sulfamethoxazole

2.2.3.1 Infants > 2 months of age and children of mild-to-moderate infections

Trimethoprim-Sulfamethoxazole 6–12 mg TMP/kg/day q12h; serious infection- Trimethoprim-Sulfamethoxazole 15–20 mg TMP/kg/day q6-8h.

3. Cellulitis^[10]

3.1 Purulent cellulitis (defined as cellulitis associated with purulent drainage or exudate in the absence of a drainable abscess)

3.1.1 In adults

Preferred regimen (1): Clindamycin 300–450 mg PO tid
Preferred regimen (2): Trimethoprim-Sulfamethoxazole 1–2 DS (double strength) tab PO bid
Preferred regimen (3): Doxycycline 100 mg PO bid
Preferred regimen (4): Minocycline 200 mg as a single dose THEN 100 mg PO bid
Preferred regimen (5): Linezolid 600 mg PO bid

3.1.2 In children

Preferred regimen (1): Clindamycin 10–13 mg/kg PO q6–8h, not to exceed 40 mg/kg/day
Preferred regimen (2): Trimethoprim 4–6 mg/kg, Sulfamethoxazole 20–30 mg/kg PO q12h
Preferred regimen (3)

3.1 If patient body weight < 45kg then Doxycycline 2 mg/kg PO q12h
3.2 If patient body weight 45kg then Doxycycline adult dose

Preferred regimen (4): Minocycline 4 mg/kg PO 200 mg as a single dose, THEN Minocycline 2 mg/kg PO q12h
Preferred regimen (5): Linezolid 10 mg/kg PO q8h, (max: 600 mg)

3.2 Nonpurulent cellulitis (defined as cellulitis with no purulent drainage or exudate and no associated abscess)

3.2.1 In adults

Preferred regimen (1): Beta-lactam (eg, Cephalexin and Dicloxacillin) 500 mg PO qid
Preferred regimen (2): Clindamycin 300–450 mg PO tid
Preferred regimen (3): Amoxicillin 500 PO mg tid
Preferred regimen (4): Linezolid 600 mg PO bid
Note (1): Empirical therapy for beta-hemolytic streptococci is recommended. Empirical coverage for CA-MRSA is recommended in patients who do not respond to beta-lactam therapy and may be considered in those with systemic toxicity.
Note (2): Provide coverage for both beta-hemolytic streptococci and CA-MRSA beta-lactam (eg, Amoxicillin) with or without Trimethoprim-Sulfamethoxazole or a Tetracycline

3.2.2 In children

Preferred regimen (1): Clindamycin 10–13 mg/kg PO q6–8h, not to exceed 40 mg/kg/day
Preferred regimen (2): Trimethoprim 4–6 mg/kg, Sulfamethoxazole 20–30 mg/kg PO q12h
Preferred regimen (3): Linezolid 10 mg/kg PO q8h, not to exceed 600 mg
Note (1): Clindamycin causes Clostridium difficile–associated disease may occur more frequently, compared with other oral agents.
Note (2): Trimethoprim-Sulfamethoxazole not recommended for women in the third trimester of pregnancy and for children ,2 months of age.
Note (3): Tetracyclines are not recommended for children under 8 years of age and are pregnancy category D.

4. Brain abscess^[11]^[12]^[13]

4.1 Methicillin-resistant Staphylococcus aureus (MRSA)

4.1.1 In adults

Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h for 4–6 weeks
Alternative regimen (1): Linezolid 600 mg PO/IV q12h for 4–6 weeks
Alternative regimen (2): Trimethoprim-Sulfamethoxazole 5 mg/kg PO/IV q8–12h for 4–6 weeks

4.1.2 In children

Preferred regimen (1): Vancomycin15 mg/kg/dose IV q6h
Preferred regimen (2): Linezolid 10 mg/kg/dose PO/IV q8h
Note: Consider the addition of Rifampin 600 mg qd OR 300–450 mg bid to Vancomycin.

4.2 Methicillin-susceptible Staphylococcus aureus (MSSA)

Preferred regimen (1): Nafcillin 2 g IV q4h
Preferred regimen (2): Oxacillin 2 g IV q4h
Alternative regimen: Vancomycin 30–45 mg/kg/day IV q8–12h

5. Cerebrospinal fluid shunt infection^[14]^[15]

5.1 Methicillin-resistant Staphylococcus aureus (MRSA)

Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h with or without Rifampin 600 mg IV or PO q24h
Note: Shunt removal is recommended, and it should not be replaced until cerebrospinal fluid cultures are repeatedly negative.

5.2 Methicillin-susceptible Staphylococcus aureus (MSSA)

Preferred regimen (1): Nafcillin 2 g IV q4h with or without Rifampin 600 mg IV/PO q24h
Preferred regimen (2): Oxacillin 2 g IV q4h

6. Spinal epidural abscess^[16]^[17]^[18]^[19]

6.1 Penicillin-susceptible Staphylococcus aureus or Streptococcus

Preferred regimen: Penicillin G 4 MU IV q4h for 2–4 weeks, THEN PO to complete 6–8 weeks

6.2 Methicillin-susceptible Staphylococcus aureus or Streptococcus

Preferred regimen (1): Cefazolin 2 g IV q8h for 2–4 weeks, THEN PO to complete 6–8 weeks
Preferred regimen (2): Nafcillin 2 g IV q4h for 2–4 weeks, THEN PO to complete 6–8 weeks
Preferred regimen (3): Oxacillin 2 g IV q4h for 2–4 weeks, THEN PO to complete 6–8 weeks
Alternative regimen: Clindamycin 600 mg IV q6h for 2–4 weeks, THEN PO to complete 6–8 weeks

6.3 Methicillin-resistant Staphylococcus aureus (MRSA)

6.3.1 In adults

Preferred regimen: Vancomycin loading dose 25–30 mg/kg IV THEN Vancomycin 15–20 mg/kg IV q8–12h for 2–4 weeks, THEN PO to complete 6–8 weeks
Alternative regimen (1): Linezolid 600 mg PO/IV q12h for 4–6 weeks
Alternative regimen (2): Trimethoprim-Sulfamethoxazole 5 mg/kg PO/IV q8–12h for 4–6 weeks

6.3.2 Pediatric dose

Preferred regimen (1): Vancomycin 15 mg/kg IV q6h
Preferred regimen (2): Linezolid 10 mg/kg PO/IV q8h

Note: Consider the addition of Rifampin 600 mg qd or 300–450 mg bid to Vancomycin in adult patients..

7. Bacterial meningitis

7.1 Methicillin susceptible Staphylococcus aureus (MSSA)

Preferred regimen (1): Nafcillin 9–12 g/day IV q4h
Preferred regimen (2): Oxacillin 9–12 g/day IV q4h
Alternative regimen (1): Vancomycin 30–45 mg/kg/day IV q8–12h
Alternative regimen (2): Meropenem 6 g/day IV q8h

7.2 Methicillin resistant Staphylococcus aureus (MRSA)

Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h
Alternative regimen (1): Trimethoprim-Sulfamethoxazole 10–20 mg/kg/day q6–12h
Alternative regimen (2): Linezolid 600 mg IV q12h
Note: Consider the addition of Rifampin 600 mg qd or 300–450 mg bid to Vancomycin in adult patients.

8. Septic thrombosis of cavernous or dural venous sinus^[20]

8.1 Methicillin-resistant Staphylococcus aureus (MRSA)

8.1.1 In adults

Preferred regimen: Vancomycin 15–20 mg/kg IV q8–12h for 4–6 weeks
Alternative regimen (1): Linezolid 600 mg PO/IV q12h for 4–6 weeks
Alternative regimen (2): Trimethoprim-Sulfamethoxazole 5 mg/kg/dose PO/IV q8–12h for 4–6 weeks

8.1.2 Pediatric dose

Preferred regimen (1): Vancomycin 15 mg/kg IV q6h
Preferred regimen (2): Linezolid 10 mg/kg PO/IV q8h
Note (1): Surgical evaluation for incision and drainage of contiguous sites of infection or abscess is recommended whenever possible.
Note (2): Consider the addition of Rifampin 600 mg qd or 300–450 mg bid to Vancomycin.

9. Subdural empyema

9.1 Methicillin-resistant Staphylococcus aureus (MRSA)^[21]

9.1.1 In adults

Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h for 4–6 weeks
Alternative regimen (1): Linezolid 600 mg PO/IV q12h for 4–6 weeks
Alternative regimen (2): Trimethoprim-Sulfamethoxazole 5 mg/kg PO/IV q8–12h for 4–6 weeks

9.1.2 In children

Preferred regimen (1): Vancomycin 15 mg/kg IV q6h
Preferred regimen (2): Linezolid 10 mg/kg PO/IV q8h
Note: Consider the addition of Rifampin 600 mg qd or 300–450 mg bid to Vancomycin.

10. Acute conjunctivitis^[22]

10.1 Methicillin-resistant Staphylococcus aureus (MRSA)

Preferred regimen: Vancomycin ointment 1% qid

11. Appendicitis

11.1 Health care–associated complicated intra-abdominal infection^[23]

11.1.1 Methicillin-resistant Staphylococcus aureus (MRSA)

Preferred regimen: Vancomycin 15–20 mg/kg IV q8–12h

12. Diverticulitis

12.1 Health care–associated complicated intra-abdominal infection^[23]

12.1.1 Methicillin-resistant Staphylococcus aureus (MRSA)

Preferred regimen: Vancomycin 15–20 mg/kg IV q8–12h.

13. Peritonitis secondary to bowel perforation, peritonitis secondary to ruptured appendix, peritonitis secondary to ruptured appendix, typhlitis

13.1 Health care–associated complicated intra-abdominal infection^[23]

13.1.1 Methicillin-resistant Staphylococcus aureus (MRSA)

Preferred regimen: Vancomycin 15–20 mg/kg IV q8–12h

14. Cystic fibrosis^[24]

14.1 Adults

14.1.1 If methicillin sensitive staphylococcus aureus

Preferred Regimen (1): Nafcillin 2 gm IV q4h
Preferred Regimen (2): Oxacillin 2 gm IV q4h

14.1.2 If methicillin resistant staphylococcus aureus

Preferred Regimen (1): Vancomycin 15-20 mg/kg IV q8-12h
Preferred Regimen (2): Linezolid 600 mg PO/IV q12h

14.2 Pediatric

14.2.1 If methicillin sensitive staphylococcus aureus

Preferred Regimen (1): Nafcillin 5 mg/kg q6h (Age >28 days)
Preferred Regimen (2): Oxacillin 75 mg/kg q6h (Age >28 days)

14.2.2 If methicillin resistant staphylococcus aureus

Preferred Regimen (1): Vancomycin 40 mg/kg q6-8h (Age >28 days)
Preferred Regimen (2): Linezolid 10 mg/kg PO/IV q8h (up to age 12)

15. Bronchiectasis^[25]

15.1 In adults

15.1.1 Recommended first-line treatment and length of treatment

15.1.1.1 Methicillin-susceptible Staphylococcus aureus (MSSA)

Preferred regimen: Flucloxacillin 500 mg PO qds for 14 days

15.1.1.2 Methicillin-resistant Staphylococcus aureus (MRSA)

Patient's body weight is < 50 kg

Preferred regimen: Rifampicin 450 mg PO qd AND Trimethoprim 200 mg PO bd for 14 days

Patient's body weight is > 50 kg

Preferred regimen: Rifampicin 600 mg PO qd AND Trimethoprim 200 mg PO bd for 14 days

15.1.1.3 Methicillin-resistant Staphylococcus aureus (MRSA)

Preferred regimen (1): Vancomycin 1 g IV bd (monitor serum levels and adjust dose accordingly)
Preferred regimen (2): Teicoplanin 400 mg qd for 14 days

15.1.2 Recommended second-line treatment and length of treatment

15.1.2.1 Methicillin-susceptible Staphylococcus aureus (MSSA)

Preferred regimen: Clarithromycin 500 mg PO bd 14 days

15.1.2.2 Methicillin-resistant Staphylococcus aureus (MRSA)

Patient's body weight is < 50 kg

Preferred regimen: Rifampicin 450 mg PO qd AND Doxycycline 200 mg PO qd for 14 days

Patient's body weight is > 50 kg

Preferred regimen: Rifampicin 600 mg PO qd AND Doxycycline 200 mg PO qd for 14 days

Third-line: Linezolid 600 mg bd for 14 days

15.1.2.3 Methicillin-resistant Staphylococcus aureus (MRSA)

Preferred regimen: Linezolid 600 mg IV bd for 14 days

15.2 In children

15.2.1 Recommended first-line treatment and length of treatment

15.2.1.1 Methicillin-susceptible Staphylococcus aureus (MSSA)

Preferred regimen: Flucloxacillin

15.2.1.2 Methicillin-resistant Staphylococcus aureus (MRSA)

15.2.1.2.1 Children (< 12 yr)

Preferred regimen: Trimethoprim 4-6 mg/kg/day PO q12h

15.2.1.2.2 Children (> 12 yr)

Preferred regimen (1): Trimethoprim 100-200 mg PO q12h
Preferred regimen (2): Rifampicin 450 mg PO od (or Rifampicin 600 mg PO od)

15.2.1.3 Methicillin-resistant Staphylococcus aureus (MRSA)

Preferred regimen (1): Vancomycin 45-60 mg/kg/day IV q8-12h
Preferred regimen (2): Teicoplanin 400 mg qd for 14 days

15.2.2 Recommended second-line treatment and length of treatment

15.2.2.1 Methicillin-susceptible Staphylococcus aureus (MSSA)

Preferred regimen: Clarithromycin 15 mg/kg/day PO q12h

15.2.2.2 Methicillin-resistant Staphylococcus aureus (MRSA)

Preferred regimen (1): Rifampicin AND Doxycycline 2-5 mg/kg/day PO/IV q12-24h (max dose: 200 mg/24 hr)
Preferred regimen (2): Rifampicin AND Doxycycline 2-5 mg/kg/day PO/IV q12-24h (max dose: 200 mg/24 hr)
Third-line: Linezolid 10 mg/kg PO/IV q12h

15.2.2.3 Methicillin-resistant Staphylococcus aureus (MRSA)

Preferred regimen: Linezolid 10 mg/kg PO/IV q12h

15.3 Long-term oral antibiotic treatment

15.3.1 In adults

15.3.1.1 Recommended first-line treatment and length of treatment

15.3.1.1.1 Methicillin-susceptible Staphylococcus aureus (MSSA)

Preferred regimen: Flucloxacillin 500 mg PO bd

15.3.1.2 Recommended second-line treatment and length of treatment

15.3.1.2.1 Methicillin-susceptible Staphylococcus aureus (MSSA)

Preferred regimen: Clarithromycin 250 mg PO bd

16. Empyema^[26]

Preferred regimen (1): Nafcillin 2 gm IV q4h
Preferred regimen (2): oxacillin 2 gm IV q4h (if MSSA)
Alternative regimen (1): Vancomycin 1 gm IV q12h
Alternative regimen (2): Linezolid 600 mg PO bid (if MRSA)

17. Community-acquired pneumonia^[27]

17.1 Methicillin-susceptible Staphylococcus aureus (MSSA)

Preferred Regimen (1): Nafcillin 1000-2000 mg q4h
Preferred Regimen (2): Oxacillin 2 g IV q4h
Preferred Regimen (3): Flucloxacillin 250 mg IM/IV q6h
Alternative Regimen (1): Cefazolin 500 mg IV q12h
Alternative Regimen (2): Clindamycin 150-450 mg PO q6-8h

17.2 Methicillin-resistant Staphylococcus aureus (MRSA)

Preferred Regimen (1): Vancomycin 45-60 mg/kg/day q8-12h (max: 2000 mg/dose) for 7-21 days
Preferred Regimen (2): Linezolid 600 mg PO/IV q12h for 10-14 days
Alternative Regimen: Trimethoprim-Sulfamethoxazole 1-2 double-strength tablets (800/160 mg) q12-24h

18. Olecranon bursitis or prepatellar bursitis

18.1 Methicillin-susceptible Staphylococcus aureus (MSSA)

Preferred regimen (1): Nafcillin 2 g IV q4h
Preferred regimen (2): Oxacillin 2 g IV q4h
Preferred regimen (3): Dicloxacillin 500 mg PO qid

18.2 Methicillin-resistant Staphylococcus aureus (MRSA)

Preferred regimen (1): Vancomycin 1 g IV q12h
Preferred regimen (2): Linezolid 600 mg PO qd
Note: Initially aspirate q24h and treat for a minimum of 2–3 weeks.

19. Septic arthritis

19.1 In adults

19.1.1 Methicillin-resistant Staphylococcus aureus (MRSA)

Preferred regimen: Vancomycin 15–20 mg/kg IV q8–12h
Alternative regimen (1): Daptomycin 6 mg/kg IV q24h in adults
Alternative regimen (2): Linezolid 600 mg PO/IV q12h
Alternative regimen (3): Clindamycin 600 mg PO/IV q8h
Alternative regimen (4): TMP-SMX 3.5–4.0 mg/kg PO/IV q8–12h

19.2.1 Methicillin-susceptible Staphylococcus aureus (MSSA)

Preferred regimen (1): Nafcillin 2 g IV q6h
Preferred regimen (2): Clindamycin 900 mg IV q8h
Alternative regimen (1): Cefazolin 0.25–1 g IV/IM q6–8h
Alternative regimen (2): Vancomycin 500 mg IV q6h or 1 g IV q12h

19.2 In childern

Preferred regimen (1): Vancomycin 15 mg/kg IV q6h
Preferred regimen (2): Daptomycin 6–10 mg/kg IV q24h
Preferred regimen (3): Linezolid 10 mg/kg PO/IV q8h
Preferred regimen (4): Clindamycin 10–13 mg/kg PO/IV q6–8h

20. Septic arthritis, prosthetic joint infection (device-related osteoarticular infections)

20.1 Methicillin-susceptible Staphylococcus aureus (MSSA)

Preferred regimen (1): Nafcillin 2 g IV q4–6h
Preferred regimen (2): Oxacillin 2 g IV q4–6h
Alternative regimen (1): Cefazolin 1–2 g IV q8h
Alternative regimen (2): Ceftriaxone 2 g IV q24h
Alternative regimen (if allergic to penicillins) (3): Clindamycin 900 mg IV q8h
Alternative regimen (if allergic to penicillins) (4): Vancomycin 15–20 mg/kg IV q8–12h, (max: 2 g per dose)

20.2 Methicillin-resistant Staphylococcus aureus (MRSA)

Early-onset (2 months after surgery) or acute hematogenous prosthetic joint infections involving a stable implant with short duration (< 3 weeks) of symptoms and debridement (but device retention)
Preferred regimen: Vancomycin AND Rifampin 600 mg PO qd or 300–450 mg PO bid for 2 weeks
Alternative regimen (1): Daptomycin 6 mg/kg IV q24h AND Rifampin 600 mg PO qd or 300–450 mg PO bid for 2 weeks
Alternative regimen (2): Linezolid 600 IV q8h AND Rifampin 600 mg PO qd or 300–450 mg PO bid for 2 weeks
Note: The above regimen should be followed by Rifampin and a Fluoroquinolone, TMP/SMX, a Tetracycline or Clindamycin for 3-6 months for hips and knees, respectively.

21. Hematogenous osteomyelitis

21.1 Adult (> 21 yrs)

21.1.1 Methicillin-resistant Staphylococcus aureus (MRSA) possible

Preferred regimen: Vancomycin 1 gm IV q12h (if over 100 kg, 1.5 gm IV q12h)

21.1.2 Methicillin-resistant Staphylococcus aureus (MRSA) unlikely

Preferred regimen (1): Nafcillin
Preferred regimen (2): Oxacillin 2 gm IV q4h

21.2 Children (> 4 months)-Adult

21.2.1 Methicillin-resistant Staphylococcus aureus (MRSA) possible

Preferred regimen: Vancomycin 40 mg IV q6–8h

21.2.2 Methicillin-resistant Staphylococcus aureus (MRSA) unlikely

Preferred regimen (1): Nafcillin
Preferred regimen (2): Oxacillin q6h (max. 8–12 gm per day)
Note: Add Ceftazidime 50 mg q8h or Cefepime 150 mg q8h if Gram negative bacilli on Gram stain

21.3 Newborn (< 4 months.)

21.3.1 Methicillin-resistant Staphylococcus aureus (MRSA) possible

Preferred regimen (1): Vancomycin AND Ceftazidime 2 gm IV q8h
Preferred regimen (2): Vancomycin AND Cefepime 2 gm IV q12h

21.3.2 Methicillin-resistant Staphylococcus aureus (MRSA) unlikely

Preferred regimen (1): Nafcillin AND Ceftazidime
Preferred regimen (2): Oxacillin AND Cefepime

21.4 Specific therapy

21.4.1 Methicillin-susceptible Staphylococcus aureus (MSSA)

Preferred regimen (1): Nafcillin
Preferred regimen (2): Oxacillin 2 gm IV q4h
Preferred regimen (3): Cefazolin 2 gm IV q8h
Alternative regimen: Vancomycin 1 gm IV q12h (if over 100 kg, 1.5 gm IV q12h)

21.4.2 Methicillin-resistant Staphylococcus aureus (MRSA)

Preferred regimen: Vancomycin 1 gm IV q12h
Alternative regimen: Linezolid 600 mg q12h PO/IV with or without Rifampin 300 mg PO/IV bid

22. Diabetic foot osteomyelitis

High risk for MRSA

Preferred regimen (1): Linezolid 600 mg IV or PO q12h
Preferred regimen (2): Daptomycin 4 mg/kg IV q24h
Preferred regimen (3): Vancomycin 15–20 mg/kg IV q8–12h (trough: 10–20 mg/L)

23. Necrotizing fasciitis^[28]

23.1 In adult

Preferred regimen (1): Nafcillin 1–2 g IV q4h (severe Pencillin allergy: Vancomycin, linezolid, quinupristin/dalfopristin, daptomycin)
Preferred regimen (2): Oxacillin 1–2 g IV q4h
Preferred regimen (3): Cefazolin 1 g IV q8h
Preferred regimen (4): Vancomycin 15 mg/kg IV bid
Preferred regimen (5): Clindamycin 600–900 mg IV q8h

23.2 In childern

Preferred regimen (1): Nafcillin 50 mg/kg/dose IV q6h (severe Pencillin allergy: Vancomycin, linezolid, quinupristin/dalfopristin, daptomycin)
Preferred regimen (2): Oxacillin 50 mg/kg/dose IV q6h
Preferred regimen (3): Cefazolin 33 mg/kg/dose IV q8h
Preferred regimen (4): Vancomycin 15 mg/kg/dose IV q6h
Preferred regimen (5): Clindamycin 10–13 mg/kg/dose IV q8h (Bacteriostatic; potential cross-resistance and emergence of resistance in erythromycin-resistant strains; inducible resistance in methicillin resistent staphylococcus aureus)

24. Staphylococcal toxic shock syndrome^[29]

24.1 Methicillin sensitive Staphylococcus aureus

Preferred regimen (1): Cloxacillin 250-500 mg PO q6h (max dose: 4 g/24 hr)
Preferred regimen (2): Nafcillin 4-12 g/24 hr IV q4-6hr (max dose: 12 g/24 hr)
Preferred regimen (3): Cefazolin 0.5-2g IV/IM q8h (max dose: 12 g/24 hr) AND Clindamycin 150-600 mg IV, IM/PO q6-8h (max dose: 5 g/24 hr IV or IM or 2 g/24 hr PO)
Alternative regimen (1): Clarithromycin 250-500 mg PO q12h (max dose: 1 g/24 hr) AND Clindamycin 150-600 mg IV, IM/PO q6-8h (max dose: 5 g/24 hr IV/IM or 2 g/24h PO)
Alternative regimen (2): Rifampicin AND Linezolid 600 mg IV/PO q12h
Alternative regimen (3): Daptomycin
Alternative regimen (4): Tigecycline 100 mg loading dose THEN 50 mg IV q12h

24.2 Methicillin resistant Staphylococcus aureus

Preferred regimen (1): Clindamycin 150-600 mg IV, IM/PO q6-8h (max dose: 5 g/24h IV/IM or 2 g/24h PO)
Preferred regimen (2): Linezolid 600 mg IV/PO q12h AND Vancomycin 15-20 mg/kg IV q8-12h, (max: 2 g per dose)
Preferred regimen (3): Teicoplanin
Alternative regimen (1): Rifampicin AND Linezolid 600 mg IV/PO q12h
Alternative regimen (2): Daptomycin
Alternative regimen (3): Tigecycline 100 mg loading dose THEN 50 mg IV q12h

24.3 Glycopeptide resistant or intermediate Staphylococcus aureus

Preferred regimen: Linezolid 600 mg IV/PO q12h AND Clindamycin 150-600 mg IV, IM/PO q6-8h (max dose: 5 g/24 hr IV/IM or 2 g/24h PO) (if sensitive)
Alternative regimen (1): Daptomycin
Alternative regimen (2): Tigecycline 100 mg loading dose THEN 50 mg IV q12h

References

↑ Chambers HF (2001). "The changing epidemiology of Staphylococcus aureus?". Emerg Infect Dis. 7 (2): 178–82. PMID 11294701.
↑ Jevons MP (1961). "Celbenin-resistant staphylococci". BMJ. 1: 124–5.
↑ Johnson AP, Aucken HM, Cavendish S, Ganner M, Wale MC, Warner M, Livermore DM, Cookson BD (2001). "Dominance of EMRSA-15 and -16 among MRSA causing nosocomial bacteraemia in the UK: analysis of isolates from the European Antimicrobial Resistance Surveillance System (EARSS)". J Antimicrob Chemother. 48 (1): 143–4. PMID 11418528.
↑ Blot SI, Vandewoude KH, Hoste EA, Colardyn FA (2002). "Outcome and attributable mortality in critically Ill patients with bacteremia involving methicillin-susceptible and methicillin-resistant Staphylococcus aureus". Arch Intern Med. 162 (19): 2229&ndash, 35. PMID 12390067.
↑ Hiramatsu K, Hanaki H, Ino T, Yabuta K, Oguri T, Tenover FC (1997). PDF "Methicillin-resistant Staphylococcus aureus clinical strain with reduced vancomycin susceptibility" Check |url= value (help). J Antimicrob Chemother. 40 (1): 135–6. PMID 9249217.
↑ Chang S, Sievert DM, Hageman JC, Boulton ML, Tenover FC, Downes FP, Shah S, Rudrik JT, Pupp GR, Brown WJ, Cardo D, Fridkin SK (2003). "Infection with vancomycin-resistant Staphylococcus aureus containing the vanA resistance gene". N Engl J Med. 348 (14): 1342–7. PMID 12672861.
↑ Menichetti F (2005). "Current and emerging serious Gram-positive infections". Clin Microbiol Infect. 11 Suppl 3: 22–8. PMID 15811021.
↑ Baddour LM, Wilson WR, Bayer AS, Fowler VG, Bolger AF, Levison ME; et al. (2005). "Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America". Circulation. 111 (23): e394–434. doi:10.1161/CIRCULATIONAHA.105.165564. PMID 15956145.
↑ Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O'Grady NP; et al. (2009). "Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America". Clin Infect Dis. 49 (1): 1–45. doi:10.1086/599376. PMC 4039170. PMID 19489710.
↑ Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL; et al. (2014). "Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America". Clin Infect Dis. 59 (2): e10–52. doi:10.1093/cid/ciu444. PMID 24973422.
↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Liu, Catherine; Bayer, Arnold; Cosgrove, Sara E.; Daum, Robert S.; Fridkin, Scott K.; Gorwitz, Rachel J.; Kaplan, Sheldon L.; Karchmer, Adolf W.; Levine, Donald P.; Murray, Barbara E.; J Rybak, Michael; Talan, David A.; Chambers, Henry F.; Infectious Diseases Society of America (2011-02-01). "Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 52 (3): –18-55. doi:10.1093/cid/ciq146. ISSN 1537-6591. PMID 21208910.
↑ Tunkel, Allan R.; Hartman, Barry J.; Kaplan, Sheldon L.; Kaufman, Bruce A.; Roos, Karen L.; Scheld, W. Michael; Whitley, Richard J. (2004-11-01). "Practice guidelines for the management of bacterial meningitis". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 39 (9): 1267–1284. doi:10.1086/425368. ISSN 1537-6591. PMID 15494903.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Kasper, Dennis (2015). Harrison's principles of internal medicine. New York: McGraw Hill Education. ISBN 978-0071802154.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Darouiche, Rabih O. (2006-11-09). "Spinal epidural abscess". The New England Journal of Medicine. 355 (19): 2012–2020. doi:10.1056/NEJMra055111. ISSN 1533-4406. PMID 17093252.
↑ Liu, Catherine; Bayer, Arnold; Cosgrove, Sara E.; Daum, Robert S.; Fridkin, Scott K.; Gorwitz, Rachel J.; Kaplan, Sheldon L.; Karchmer, Adolf W.; Levine, Donald P.; Murray, Barbara E.; J Rybak, Michael; Talan, David A.; Chambers, Henry F.; Infectious Diseases Society of America (2011-02-01). "Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 52 (3): –18-55. doi:10.1093/cid/ciq146. ISSN 1537-6591. PMID 21208910.
↑ Liu, Catherine; Bayer, Arnold; Cosgrove, Sara E.; Daum, Robert S.; Fridkin, Scott K.; Gorwitz, Rachel J.; Kaplan, Sheldon L.; Karchmer, Adolf W.; Levine, Donald P.; Murray, Barbara E.; J Rybak, Michael; Talan, David A.; Chambers, Henry F.; Infectious Diseases Society of America (2011-02-01). "Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 52 (3): –18-55. doi:10.1093/cid/ciq146. ISSN 1537-6591. PMID 21208910.
↑ Liu, Catherine; Bayer, Arnold; Cosgrove, Sara E.; Daum, Robert S.; Fridkin, Scott K.; Gorwitz, Rachel J.; Kaplan, Sheldon L.; Karchmer, Adolf W.; Levine, Donald P.; Murray, Barbara E.; J Rybak, Michael; Talan, David A.; Chambers, Henry F.; Infectious Diseases Society of America (2011-02-01). "Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 52 (3): –18-55. doi:10.1093/cid/ciq146. ISSN 1537-6591. PMID 21208910.
↑ Azari, Amir A.; Barney, Neal P. (2013-10-23). "Conjunctivitis: a systematic review of diagnosis and treatment". JAMA. 310 (16): 1721–1729. doi:10.1001/jama.2013.280318. ISSN 1538-3598. PMC 4049531. PMID 24150468.CS1 maint: PMC format (link)
↑ ^23.0 ^23.1 ^23.2 Solomkin JS, Mazuski JE, Bradley JS, Rodvold KA, Goldstein EJ, Baron EJ; et al. (2010). "Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America". Clin Infect Dis. 50 (2): 133–64. doi:10.1086/649554. PMID 20034345.
↑ Mogayzel PJ, Naureckas ET, Robinson KA, Mueller G, Hadjiliadis D, Hoag JB; et al. (2013). "Cystic fibrosis pulmonary guidelines. Chronic medications for maintenance of lung health". Am J Respir Crit Care Med. 187 (7): 680–9. PMID 23540878.
↑ Pasteur MC, Bilton D, Hill AT, British Thoracic Society Bronchiectasis non-CF Guideline Group (2010). "British Thoracic Society guideline for non-CF bronchiectasis". Thorax. 65 Suppl 1: i1–58. doi:10.1136/thx.2010.136119. PMID 20627931.
↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
↑ Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC; et al. (2007). "Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults". Clin Infect Dis. 44 Suppl 2: S27–72. doi:10.1086/511159. PMID 17278083.
↑ Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL; et al. (2014). "Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America". Clin Infect Dis. 59 (2): 147–59. doi:10.1093/cid/ciu296. PMID 24947530.
↑ Lappin E, Ferguson AJ (2009). "Gram-positive toxic shock syndromes". Lancet Infect Dis. 9 (5): 281–90. doi:10.1016/S1473-3099(09)70066-0. PMID 19393958.

[EmergInfectDis2001-Chambers-1] Chambers HF (2001). "The changing epidemiology of Staphylococcus aureus?". Emerg Infect Dis. 7 (2): 178–82. PMID 11294701.

[BMJ1961-Jevons-2] Jevons MP (1961). "Celbenin-resistant staphylococci". BMJ. 1: 124–5.

[JAntimicrobChemother2001-Johnson-3] Johnson AP, Aucken HM, Cavendish S, Ganner M, Wale MC, Warner M, Livermore DM, Cookson BD (2001). "Dominance of EMRSA-15 and -16 among MRSA causing nosocomial bacteraemia in the UK: analysis of isolates from the European Antimicrobial Resistance Surveillance System (EARSS)". J Antimicrob Chemother. 48 (1): 143–4. PMID 11418528.

[ArchInternMed2002-Blot-4] Blot SI, Vandewoude KH, Hoste EA, Colardyn FA (2002). "Outcome and attributable mortality in critically Ill patients with bacteremia involving methicillin-susceptible and methicillin-resistant Staphylococcus aureus". Arch Intern Med. 162 (19): 2229&ndash, 35. PMID 12390067.

[JAntimicrobChemother1997-Hiramatsu-5] Hiramatsu K, Hanaki H, Ino T, Yabuta K, Oguri T, Tenover FC (1997). PDF "Methicillin-resistant Staphylococcus aureus clinical strain with reduced vancomycin susceptibility" Check |url= value (help). J Antimicrob Chemother. 40 (1): 135–6. PMID 9249217.

[NEJM-Chang-6] Chang S, Sievert DM, Hageman JC, Boulton ML, Tenover FC, Downes FP, Shah S, Rudrik JT, Pupp GR, Brown WJ, Cardo D, Fridkin SK (2003). "Infection with vancomycin-resistant Staphylococcus aureus containing the vanA resistance gene". N Engl J Med. 348 (14): 1342–7. PMID 12672861.

[ClinMicroInf2005-Menichetti-7] Menichetti F (2005). "Current and emerging serious Gram-positive infections". Clin Microbiol Infect. 11 Suppl 3: 22–8. PMID 15811021.

[pmid15956145-8] Baddour LM, Wilson WR, Bayer AS, Fowler VG, Bolger AF, Levison ME; et al. (2005). "Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America". Circulation. 111 (23): e394–434. doi:10.1161/CIRCULATIONAHA.105.165564. PMID 15956145.

[pmid19489710-9] Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O'Grady NP; et al. (2009). "Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America". Clin Infect Dis. 49 (1): 1–45. doi:10.1086/599376. PMC 4039170. PMID 19489710.

[pmid24973422-10] Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL; et al. (2014). "Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America". Clin Infect Dis. 59 (2): e10–52. doi:10.1093/cid/ciu444. PMID 24973422.

[11] Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.

[12] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[13] Liu, Catherine; Bayer, Arnold; Cosgrove, Sara E.; Daum, Robert S.; Fridkin, Scott K.; Gorwitz, Rachel J.; Kaplan, Sheldon L.; Karchmer, Adolf W.; Levine, Donald P.; Murray, Barbara E.; J Rybak, Michael; Talan, David A.; Chambers, Henry F.; Infectious Diseases Society of America (2011-02-01). "Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 52 (3): –18-55. doi:10.1093/cid/ciq146. ISSN 1537-6591. PMID 21208910.

[14] Tunkel, Allan R.; Hartman, Barry J.; Kaplan, Sheldon L.; Kaufman, Bruce A.; Roos, Karen L.; Scheld, W. Michael; Whitley, Richard J. (2004-11-01). "Practice guidelines for the management of bacterial meningitis". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 39 (9): 1267–1284. doi:10.1086/425368. ISSN 1537-6591. PMID 15494903.

[15] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[16] Kasper, Dennis (2015). Harrison's principles of internal medicine. New York: McGraw Hill Education. ISBN 978-0071802154.

[17] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[18] Darouiche, Rabih O. (2006-11-09). "Spinal epidural abscess". The New England Journal of Medicine. 355 (19): 2012–2020. doi:10.1056/NEJMra055111. ISSN 1533-4406. PMID 17093252.

[19] Liu, Catherine; Bayer, Arnold; Cosgrove, Sara E.; Daum, Robert S.; Fridkin, Scott K.; Gorwitz, Rachel J.; Kaplan, Sheldon L.; Karchmer, Adolf W.; Levine, Donald P.; Murray, Barbara E.; J Rybak, Michael; Talan, David A.; Chambers, Henry F.; Infectious Diseases Society of America (2011-02-01). "Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 52 (3): –18-55. doi:10.1093/cid/ciq146. ISSN 1537-6591. PMID 21208910.

[20] Liu, Catherine; Bayer, Arnold; Cosgrove, Sara E.; Daum, Robert S.; Fridkin, Scott K.; Gorwitz, Rachel J.; Kaplan, Sheldon L.; Karchmer, Adolf W.; Levine, Donald P.; Murray, Barbara E.; J Rybak, Michael; Talan, David A.; Chambers, Henry F.; Infectious Diseases Society of America (2011-02-01). "Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 52 (3): –18-55. doi:10.1093/cid/ciq146. ISSN 1537-6591. PMID 21208910.

[21] Liu, Catherine; Bayer, Arnold; Cosgrove, Sara E.; Daum, Robert S.; Fridkin, Scott K.; Gorwitz, Rachel J.; Kaplan, Sheldon L.; Karchmer, Adolf W.; Levine, Donald P.; Murray, Barbara E.; J Rybak, Michael; Talan, David A.; Chambers, Henry F.; Infectious Diseases Society of America (2011-02-01). "Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 52 (3): –18-55. doi:10.1093/cid/ciq146. ISSN 1537-6591. PMID 21208910.

[22] Azari, Amir A.; Barney, Neal P. (2013-10-23). "Conjunctivitis: a systematic review of diagnosis and treatment". JAMA. 310 (16): 1721–1729. doi:10.1001/jama.2013.280318. ISSN 1538-3598. PMC 4049531. PMID 24150468.CS1 maint: PMC format (link)

[pmid20034345-23] 23.0 ^23.1 ^23.2 Solomkin JS, Mazuski JE, Bradley JS, Rodvold KA, Goldstein EJ, Baron EJ; et al. (2010). "Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America". Clin Infect Dis. 50 (2): 133–64. doi:10.1086/649554. PMID 20034345.

[pmid23540878-24] Mogayzel PJ, Naureckas ET, Robinson KA, Mueller G, Hadjiliadis D, Hoag JB; et al. (2013). "Cystic fibrosis pulmonary guidelines. Chronic medications for maintenance of lung health". Am J Respir Crit Care Med. 187 (7): 680–9. PMID 23540878.

[pmid20627931-25] Pasteur MC, Bilton D, Hill AT, British Thoracic Society Bronchiectasis non-CF Guideline Group (2010). "British Thoracic Society guideline for non-CF bronchiectasis". Thorax. 65 Suppl 1: i1–58. doi:10.1136/thx.2010.136119. PMID 20627931.

[26] Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.

[pmid17278083-27] Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC; et al. (2007). "Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults". Clin Infect Dis. 44 Suppl 2: S27–72. doi:10.1086/511159. PMID 17278083.

[pmid24947530-28] Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL; et al. (2014). "Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America". Clin Infect Dis. 59 (2): 147–59. doi:10.1093/cid/ciu296. PMID 24947530.

[pmid19393958-29] Lappin E, Ferguson AJ (2009). "Gram-positive toxic shock syndromes". Lancet Infect Dis. 9 (5): 281–90. doi:10.1016/S1473-3099(09)70066-0. PMID 19393958.

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@@ Line 2: / Line 2: @@
 {{Staphylococcus aureus infection}}
 {{CMG}}
+==Overview==
+Antimicrobial therapy is the mainstay of therapy for infections caused by ''Staphylococcus aureus''.  ''Staphylcoccus aureus'' has developed resistance to numerous commonly used antibiotics.  The preferred antimicrobial agents for infections caused by methicillin-resistant ''Staphylococcus aureus'' (MRSA) include [[Vancomycin]] and non beta-lactam antibiotics such as [[Clindamycin]] and [[TMP-SMX]].
+==Medical Therapy==
+===Antibiotic resistance===
+{{details|Methicillin-resistant Staphylococcus aureus}}
+Staph infection that is not antibiotic resistant can be treated in about a month (depending on severity) using antibiotics.
+Antibiotic resistance in ''S. aureus'' was almost unknown when penicillin was first introduced in 1943; indeed, the original petri dish on which [[Alexander Fleming]] observed the antibacterial activity of the [[Penicillium notatum|penicillium]] mould was growing a culture of ''S. aureus''. By 1950, 40% of hospital ''S. aureus'' isolates were penicillin resistant; and by 1960, this had risen to 80%.<ref name="EmergInfectDis2001-Chambers">{{cite journal | author=Chambers HF | title=The changing epidemiology of Staphylococcus aureus? | journal=Emerg Infect Dis | year=2001 | pages=178–82 | volume=7 | issue=2 | id=PMID 11294701 | url= http://www.cdc.gov/ncidod/eid/vol7no2/chambers.htm}}</ref>
+===Mechanisms of antibiotic resistance===
+Staphylococcal resistance to [[Penicillin]] is mediated by [[penicillinase]] (a form of [[beta-lactamase|β-lactamase]]) production: an enzyme which breaks down the β-lactam ring of the penicillin molecule. Penicillinase-resistant penicillins such as [[Methicillin]], [[Oxacillin]], [[Cloxacillin]], [[Dicloxacillin]] and [[Flucloxacillin]] are able to resist degradation by staphylococcal penicillinase.
+The mechanism of resistance to methicillin is by the acquisition of the mecA gene, which codes for an altered [[penicillin-binding protein]] (PBP) that has a lower affinity for binding β-lactams ([[Penicillin]]s, [[Cephalosporin]]s and [[carbapenem]]s).  This confers resistance to all β-lactam antibiotics and obviates their clinical use during [[MRSA]] infections.
+Glycopeptide resistance is mediated by acquisition of the vanA gene.  The vanA gene originates from the [[Enterococcus|enterococci]] and codes for an enzyme that produces an alternative [[peptidoglycan]] to which [[Vancomycin]] will not bind.
+Today, ''S. aureus'' has become [[antibiotic resistance|resistant]] to many commonly used antibiotics.  In the UK, only 2% of all ''S. aureus'' isolates are sensitive to [[penicillin]] with a similar picture in the rest of the world, due to a [[penicillinase]] (a form of [[β-lactamase]]). The β-lactamase-resistant [[penicillin]]s ([[Methicillin]], [[Oxacillin]], [[Cloxacillin]] and [[Flucloxacillin]]) were developed to treat penicillin-resistant ''S. aureus'' and are still used as first-line treatment.  [[Methicillin]] was the first antibiotic in this class to be used (it was introduced in 1959), but only two years later, the first case of [[methicillin resistant staphylococcus aureus|methicillin-resistant ''S. aureus'']] ('''MRSA''') was reported in England.<ref name="BMJ1961-Jevons">{{cite journal | author=Jevons MP | title=Celbenin-resistant staphylococci | journal=BMJ | volume=1 | year=1961 | pages=124–5}}</ref>
+Despite this, MRSA generally remained an uncommon finding even in hospital settings until the 1990s when there was an explosion in MRSA prevalence in hospitals where it is now [[Endemic (epidemiology)|endemic]].<!--
+  --><ref name="JAntimicrobChemother2001-Johnson">{{cite journal | author=Johnson AP, Aucken HM, Cavendish S, Ganner M, Wale MC, Warner M, Livermore DM, Cookson BD | title=Dominance of EMRSA-15 and -16 among MRSA causing nosocomial bacteraemia in the UK: analysis of isolates from the European Antimicrobial Resistance Surveillance System (EARSS) | journal=J Antimicrob Chemother | year=2001 | pages=143–4 | volume=48 | issue=1 | id=PMID 11418528 |url = http://jac.oxfordjournals.org/cgi/content/full/48/1/143 }}</ref>
+MRSA infections in both the hospital and community setting are commonly treated with non-β-lactam antibiotics such as [[Clindamycin]] (a lincosamine) and [[Co-trimoxazole]] (also commonly known as trimethoprim/sulfamethoxazole).  Resistance to these antibiotics has also led to the use of new, broad-spectrum anti-Gram positive antibiotics such as [[Linezolid]] because of its availability as an oral drug. First-line treatment for serious invasive infections due to MRSA is currently [[glycopeptide]] antibiotics ([[Vancomycin]] and [[Teicoplanin]]).  There are number of problems with these antibiotics, mainly centered around the need for intravenous administration (there is no oral preparation available), toxicity and the need to monitor drug levels regularly by means of blood tests.  There are also concerns that glycopeptide antibiotics do not penetrate very well into infected tissues (this is a particular concern with infections of the brain and [[meninges]] and in [[endocarditis]]).  Glycopeptides must not be used to treat methicillin-sensitive ''S. aureus'' as outcomes are inferior.<!--
+  --><ref name="ArchInternMed2002-Blot">{{cite journal | author=Blot SI, Vandewoude KH, Hoste EA, Colardyn FA | title=Outcome and attributable mortality in critically Ill patients with bacteremia involving methicillin-susceptible and methicillin-resistant Staphylococcus aureus | journal=Arch Intern Med | year=2002 | pages=2229&ndash;35 | volume=162 | issue=19 | id=PMID 12390067 | url=http://archinte.ama-assn.org/cgi/content/full/162/19/2229 }}</ref>
+Because of the high level of resistance to penicillins, and because of the potential for MRSA to develop resistance to [[Vancomycin]], the [[Centers for Disease Control and Prevention]] have published [http://wonder.cdc.gov/wonder/prevguid/m0039349/m0039349.asp guidelines]for the appropriate use of [[Vancomycin]]. In situations where the incidence of MRSA infections is known to be high, the attending physician may choose to use a glycopeptide [[antibiotic]] until the identity of the infecting organism is known.  When the infection is confirmed to be due to a methicillin-susceptible strain of ''S. aureus'', then treatment can be changed to [[Flucloxacillin]] or even [[Penicillin]] as appropriate.
+[[Vancomycin-resistant Staphylococcus aureus|Vancomycin-resistant ''S. aureus'']] ('''VRSA''') is a strain of ''S. aureus'' that has become resistant to the glycopeptides.
+The first case of '''vancomycin-intermediate ''S. aureus''''' ('''VISA''') was reported in Japan in 1996;<!--
+  --><ref name="JAntimicrobChemother1997-Hiramatsu">{{cite journal | author=Hiramatsu K, Hanaki H, Ino T, Yabuta K, Oguri T, Tenover FC | title=Methicillin-resistant Staphylococcus aureus clinical strain with reduced vancomycin susceptibility | journal=J Antimicrob Chemother | year=1997 | pages=135–6 | volume=40 | issue=1 | id=PMID 9249217 | url=http://jac.oxfordjournals.org/cgi/reprint/40/1/135.pdf PDF}}</ref>
+but the first case of ''S. aureus'' truly resistant to glycopeptide antibiotics was only reported in 2002.<!--
+  --><ref name="NEJM-Chang">{{cite journal | author=Chang S, Sievert DM, Hageman JC, Boulton ML, Tenover FC, Downes FP, Shah S, Rudrik JT, Pupp GR, Brown WJ, Cardo D, Fridkin SK | title=Infection with vancomycin-resistant Staphylococcus aureus containing the vanA resistance gene | journal=N Engl J Med | year=2003 | pages=1342–7 | volume=348 | issue=14 | id=PMID 12672861}}</ref>
+Three cases of VRSA infection have been reported in the United States as of 2005.<!--
+  --><ref name="ClinMicroInf2005-Menichetti">{{cite journal | author=Menichetti F | title=Current and emerging serious Gram-positive infections | journal=Clin Microbiol Infect | year=2005 | pages=22–8 | volume=11 Suppl 3 | id=PMID 15811021}}</ref>
+===Antimicrobial Regimen===
+:* [[Staphylococcus aureus]] treatment
+::* 1. '''Infectious endocarditis'''<ref name="pmid15956145">{{cite journal| author=Baddour LM, Wilson WR, Bayer AS, Fowler VG, Bolger AF, Levison ME et al.| title=Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America. | journal=Circulation | year= 2005 | volume= 111 | issue= 23 | pages= e394-434 | pmid=15956145 | doi=10.1161/CIRCULATIONAHA.105.165564 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15956145  }} </ref>
+:::* 1.1 In adults
+::::* Preferred regimen (1): [[Vancomycin]] 15-20 mg/kg IV q8-12h
+::::* Preferred regimen (2): [[Daptomycin]] 6mg/kg/dose IV qd
+::* 2. '''Intravascular catheter-related infections'''<ref name="pmid19489710">{{cite journal| author=Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O'Grady NP et al.| title=Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2009 | volume= 49 | issue= 1 | pages= 1-45 | pmid=19489710 | doi=10.1086/599376 | pmc=PMC4039170 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19489710  }} </ref>
+:::* 2.1 '''Methicillin susceptible Staphylococcus aureus (MSSA)'''
+::::* Preferred regimen (1): [[Nafcillin]] 2 g IV q6h
+::::* Preferred regimen (2): [[Oxacillin]] 2 g IV q6h
+::::* Alternative regimen (1): [[Cefazolin]] 2 g IV q8h
+::::* Alternative regimen (2): [[Vancomycin]] 15 mg/kg IV q12h
+:::::* 2.1.1 '''Pediatric dose of Nafcillin'''
+::::::* 2.1.1.1 '''Neonates (< 4 weeks)'''
+:::::::* For < 1200 g: [[Nafcillin]] 50 mg/kg/day q12h
+:::::::* For ≤ 7 days of age and 1200–2000 g: [[Nafcillin]] 50 mg/kg/day q12h
+:::::::* For ≤ 7 days of age and > 2000 g: [[Nafcillin]] 75 mg/kg/day q8h
+:::::::* For > 7 days of age and 1200–2000 g: [[Nafcillin]] 75 mg/kg/day q8h
+:::::::* For > 7 days of age and > 2000 g: [[Nafcillin]] 100 mg/kg/day q6h
+::::::* 2.1.1.2 '''Infants and children (> 4 weeks)'''
+:::::::* [[Nafcillin]] 100–200 mg/kg/day q4–6h
+:::::* 2.1.2 '''Pediatric dose of Oxacillin'''
+::::::* 2.1.2.1 '''Neonates (< 4 weeks)'''
+:::::::* For < 1200 g: [[Oxacillin]] 50 mg/kg/day q12h
+:::::::* For Postnatal age < 7 days and 1200–2000 g: [[Oxacillin]] 50–100 mg/kg/day q12h
+:::::::* For Postnatal age < 7 days and > 2000 g: [[Oxacillin]] 75–150 mg/kg/day q8h
+:::::::* For Postnatal age ≥ 7 days and 1200–2000 g: [[Oxacillin]] 75–150 mg/kg/day q8h
+:::::::* For Postnatal age ≥ 7 days and > 2000 g: [[Oxacillin]] 100–200 mg/kg/day q6h
+::::::* 2.1.2.2 '''Infants and children'''(> 4weeks)
+:::::::* [[Oxacillin]] 150–200 mg/kg/day q4–6h
+:::::* 2.1.3 '''Pediatric dose of Cefazolin'''
+::::::* 2.1.3.1 '''Neonates (< 4 weeks)'''
+:::::::* Postnatal age ≤ 7 days: [[Cefazolin]] 40 mg/kg/day q12h
+:::::::* Postnatal age > 7 days and ≤ 2000 g: [[Cefazolin]] 40 mg/kg/day q12h
+:::::::* Postnatal age > 7 days and > 2000 g: [[Cefazolin]] 60 mg/kg/day q8h
+::::::* 2.1.3.2 '''Infants and children (> 4 weeks)'''
+:::::::* [[Cefazolin]] 50 mg/kg/day q8h.
+:::::* 2.1.4 '''Pediatric dose of Vancomycin'''
+::::::* 2.1.4.1 '''Neonates (< 4 weeks)'''
+:::::::* Postnatal age ≤ 7 days and < 1200 g: [[Vancomycin]] 15 mg/kg/day q24h.
+:::::::* Postnatal age ≤ 7 days and 1200–2000 g: [[Vancomycin]] 10–15 mg/kg q12–18h.
+:::::::* Postnatal age ≤ 7 days and > 2000 g: [[Vancomycin]] 10–15 mg/kg q8–12h.
+:::::::* Postnatal age > 7 days and < 1200 g: [[Vancomycin]] 15 mg/kg/day q24h.
+:::::::* Postnatal age > 7 days and 1200–2000 g: [[Vancomycin]] 10–15 mg/kg q8–12h.
+:::::::* Postnatal age > 7 days and > 2000 g: [[Vancomycin]] 15–20 mg/kg q8h.
+::::::* 2.1.4.2 '''Infants and children (> 4 weeks)'''
+:::::::* [[Vancomycin]] 40 mg/kg/day q6–8h.
+:::* 2.2 '''Methicillin resistant Staphylococcus aureus (MRSA)'''
+::::* Preferred regimen (1): [[Vancomycin]] 15 mg/kg IV q12h
+::::* Preferred regimen (2): [[Daptomycin]] 6–8 mg/kg/day IV
+::::* Preferred regimen (3): [[Linezolid]] 10 mg/kg IV/PO q12h
+::::* Preferred regimen (4): [[Vancomycin]] 15 mg/kg IV q12h {{and}} ([[Rifampicin]] IV or [[Gentamycin]] IV)
+::::* Preferred regimen (5): [[Trimethoprim-Sulfamethoxazole]] 6–12 mg TMP/kg/day q12h alone (if susceptible)
+:::::* 2.2.1 '''Pediatric dose of Linezolid'''
+::::::* 2.2.1.1 '''Neonates (< 4 weeks)'''
+:::::::* For < 1200 g: [[Linezolid]] 10 mg/kg q8–12h (note: q12h in patients < 34 weeks gestation and < 1 week of age).
+:::::::* For < 7 days of age and ≥ 1200 g: [[Linezolid]] 10 mg/kg q8–12h (note: q12h in patients < 34 weeks gestation and < 1 week of age).
+:::::::* For ≥ 7 days and ≥ 1200 g: [[Linezolid]] 10 mg/kg q8h
+::::::* 2.2.1.2 '''Infants and children < 12 years (> 4 weeks)'''
+:::::::* [[Linezolid]] 10 mg/kg q8h
+::::::* 2.2.1.3 '''Children ≥ 12 years and adolescents'''
+:::::::* [[Linezolid]] 10 mg/kg q12h
+:::::* 2.2.2 '''Pediatric dose of Gentamycin'''
+::::::* 2.2.2.1 '''Neonates (< 4 weeks)'''
+:::::::* Premature neonates and < 1000 g: [[Gentamycin]] 3.5 mg/kg q24h
+:::::::* < 1200 g: [[Gentamycin]] 2.5 mg/kg q18-24h.
+:::::::* Postnatal age ≤ 7 days: [[Gentamycin]] 2.5 mg/kg q12h.
+:::::::* Postnatal age > 7 days and 1200–2000 g: [[Gentamycin]] 2.5 mg/kg q8-12h.
+:::::::* Postnatal age > 7 days and > 1200 g: [[Gentamycin]] 2.5 mg/kg q8h.
+:::::::* Premature neonates with normal renal function: [[Gentamycin]] 3.5–4 mg/kg q24h.
+:::::::* Term neonates with normal renal function: [[Gentamycin]] 3.5–5 mg/kg q24h.
+::::::* 2.2.2.2 '''Infants and children < 5 years (> 4 weeks)'''
+:::::::* [[Gentamycin]] 2.5 mg/kg q8h; qd dosing in patients with normal renal function, [[Gentamycin]] 5–7.5 mg/kg q24h.
+::::::* 2.2.2.3 '''Children ≥ 5 years '''
+:::::::* [[Gentamycin]] 2–2.5 mg/kg q8h; qd with normal renal function, [[Gentamycin]] 5–7.5 mg/kg q24h.
+:::::* 2.2.3 '''Pediatric dose of Trimethoprim-Sulfamethoxazole'''
+::::::* 2.2.3.1 '''Infants > 2 months of age and children of mild-to-moderate infections '''
+:::::::* [[Trimethoprim-Sulfamethoxazole]] 6–12 mg TMP/kg/day q12h; serious infection- [[Trimethoprim-Sulfamethoxazole]] 15–20 mg TMP/kg/day  q6-8h.
+::* 3. '''Cellulitis'''<ref name="pmid24973422">{{cite journal| author=Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL et al.| title=Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2014 | volume= 59 | issue= 2 | pages= e10-52 | pmid=24973422 | doi=10.1093/cid/ciu444 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24973422  }} </ref>
+::: 3.1 '''Purulent cellulitis''' (defined as cellulitis associated with purulent drainage or exudate in the absence of a drainable abscess)
+::::* 3.1.1 '''In adults'''
+:::::* Preferred regimen (1): [[Clindamycin]] 300–450 mg PO tid
+:::::* Preferred regimen (2): [[Trimethoprim-Sulfamethoxazole]] 1–2 DS (double strength) tab PO bid
+:::::* Preferred regimen (3): [[Doxycycline]] 100 mg PO bid
+:::::* Preferred regimen (4): [[Minocycline]] 200 mg as a single dose {{then}} 100 mg PO bid
+:::::* Preferred regimen (5): [[Linezolid]] 600 mg PO bid
+:::* 3.1.2 '''In children'''
+::::* Preferred regimen (1): [[Clindamycin]] 10–13 mg/kg PO q6–8h, not to exceed 40 mg/kg/day
+::::* Preferred regimen (2): [[Trimethoprim]] 4–6 mg/kg, [[Sulfamethoxazole]] 20–30 mg/kg PO q12h
+::::* Preferred regimen (3)
+:::::* 3.1 If patient body weight < 45kg then [[Doxycycline]] 2 mg/kg PO q12h
+:::::* 3.2 If patient body weight 45kg then [[Doxycycline]] adult dose
+::::* Preferred regimen (4): [[Minocycline]] 4 mg/kg PO 200 mg as a single dose, {{then}} [[Minocycline]] 2 mg/kg PO q12h
+::::* Preferred regimen (5): [[Linezolid]] 10 mg/kg PO q8h, (max: 600 mg)
+::* 3.2 '''Nonpurulent cellulitis''' (defined as cellulitis with no purulent drainage or exudate and no associated abscess)
+:::* 3.2.1 '''In adults'''
+::::* Preferred regimen (1): Beta-lactam (eg, [[Cephalexin]] and [[Dicloxacillin]]) 500 mg PO qid
+::::* Preferred regimen (2): [[Clindamycin]] 300–450 mg PO tid
+::::* Preferred regimen (3): [[Amoxicillin]] 500 PO mg tid
+::::* Preferred regimen (4): [[Linezolid]] 600 mg PO bid
+::::* Note (1): Empirical therapy for beta-hemolytic streptococci is recommended. Empirical coverage for CA-MRSA is recommended in patients who do not respond to beta-lactam therapy and may be considered in those with systemic toxicity.
+::::* Note (2): Provide coverage for both beta-hemolytic streptococci and CA-MRSA beta-lactam (eg, [[Amoxicillin]]) with or without [[Trimethoprim-Sulfamethoxazole]] or a [[Tetracycline]]
+:::* 3.2.2 '''In children'''
+::::* Preferred regimen (1): [[Clindamycin]] 10–13 mg/kg PO q6–8h, not to exceed 40 mg/kg/day
+::::* Preferred regimen (2): [[Trimethoprim]] 4–6 mg/kg, [[Sulfamethoxazole]] 20–30 mg/kg PO q12h
+::::* Preferred regimen (3): [[Linezolid]] 10 mg/kg PO q8h, not to exceed 600 mg
+::::* Note (1): [[Clindamycin]] causes Clostridium difficile–associated disease may occur more frequently, compared with other oral agents.
+::::* Note (2): [[Trimethoprim-Sulfamethoxazole]] not recommended for women in the third trimester of pregnancy and for children ,2 months of age.
+::::* Note (3): [[Tetracyclines]] are not recommended for children under 8 years of age and are pregnancy category D.
+::* 4. '''Brain abscess'''<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref><ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref><ref>{{Cite journal| doi = 10.1093/cid/ciq146| issn = 1537-6591| volume = 52| issue = 3| pages = –18-55| last1 = Liu| first1 = Catherine| last2 = Bayer| first2 = Arnold| last3 = Cosgrove| first3 = Sara E.| last4 = Daum| first4 = Robert S.| last5 = Fridkin| first5 = Scott K.| last6 = Gorwitz| first6 = Rachel J.| last7 = Kaplan| first7 = Sheldon L.| last8 = Karchmer| first8 = Adolf W.| last9 = Levine| first9 = Donald P.| last10 = Murray| first10 = Barbara E.| last11 = J Rybak| first11 = Michael| last12 = Talan| first12 = David A.| last13 = Chambers| first13 = Henry F.| last14 = Infectious Diseases Society of America| title = Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2011-02-01| pmid = 21208910}}</ref>
+:::* 4.1 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
+::::* 4.1.1 '''In adults'''
+:::::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h for 4–6 weeks
+:::::* Alternative regimen (1): [[Linezolid]] 600 mg PO/IV q12h for 4–6 weeks
+:::::* Alternative regimen (2): [[Trimethoprim-Sulfamethoxazole]] 5 mg/kg PO/IV q8–12h for 4–6 weeks
+::::* 4.1.2 '''In children'''
+:::::* Preferred regimen (1): [[Vancomycin]]15 mg/kg/dose IV q6h
+:::::* Preferred regimen (2): [[Linezolid]] 10 mg/kg/dose PO/IV q8h
+:::::* Note: Consider the addition of [[Rifampin]] 600 mg qd {{or}} 300–450 mg bid to [[Vancomycin]].
+:::* 4.2 '''Methicillin-susceptible Staphylococcus aureus (MSSA)'''
+::::* Preferred regimen (1): [[Nafcillin]] 2 g IV q4h
+::::* Preferred regimen (2): [[Oxacillin]] 2 g IV q4h
+::::* Alternative regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h
+::* 5. '''Cerebrospinal fluid shunt infection'''<ref>{{Cite journal| doi = 10.1086/425368| issn = 1537-6591| volume = 39| issue = 9| pages = 1267–1284| last1 = Tunkel| first1 = Allan R.| last2 = Hartman| first2 = Barry J.| last3 = Kaplan| first3 = Sheldon L.| last4 = Kaufman| first4 = Bruce A.| last5 = Roos| first5 = Karen L.| last6 = Scheld| first6 = W. Michael| last7 = Whitley| first7 = Richard J.| title = Practice guidelines for the management of bacterial meningitis| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2004-11-01| pmid = 15494903}}</ref><ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+:::* 5.1 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
+::::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h with or without [[Rifampin]] 600 mg IV or PO q24h
+::::* Note: Shunt removal is recommended, and it should not be replaced until cerebrospinal fluid cultures are repeatedly negative.
+:::* 5.2 '''Methicillin-susceptible Staphylococcus aureus (MSSA)'''
+::::* Preferred regimen (1): [[Nafcillin]] 2 g IV q4h with or without [[Rifampin]] 600 mg IV/PO q24h
+::::* Preferred regimen (2): [[Oxacillin]] 2 g IV q4h
+::* 6. '''Spinal epidural abscess'''<ref>{{cite book | last = Kasper | first = Dennis | title = Harrison's principles of internal medicine | publisher = McGraw Hill Education | location = New York | year = 2015 | isbn = 978-0071802154 }}</ref><ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref><ref>{{Cite journal| doi = 10.1056/NEJMra055111| issn = 1533-4406| volume = 355| issue = 19| pages = 2012–2020| last = Darouiche| first = Rabih O.| title = Spinal epidural abscess| journal = The New England Journal of Medicine| date = 2006-11-09| pmid = 17093252}}</ref><ref>{{Cite journal| doi = 10.1093/cid/ciq146| issn = 1537-6591| volume = 52| issue = 3| pages = –18-55| last1 = Liu| first1 = Catherine| last2 = Bayer| first2 = Arnold| last3 = Cosgrove| first3 = Sara E.| last4 = Daum| first4 = Robert S.| last5 = Fridkin| first5 = Scott K.| last6 = Gorwitz| first6 = Rachel J.| last7 = Kaplan| first7 = Sheldon L.| last8 = Karchmer| first8 = Adolf W.| last9 = Levine| first9 = Donald P.| last10 = Murray| first10 = Barbara E.| last11 = J Rybak| first11 = Michael| last12 = Talan| first12 = David A.| last13 = Chambers| first13 = Henry F.| last14 = Infectious Diseases Society of America| title = Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2011-02-01| pmid = 21208910}}</ref>
+:::* 6.1 '''Penicillin-susceptible Staphylococcus aureus or Streptococcus'''
+::::* Preferred regimen: [[Penicillin G]] 4 MU IV q4h for 2–4 weeks, {{then}} PO to complete 6–8 weeks
+:::* 6.2 '''Methicillin-susceptible Staphylococcus aureus or Streptococcus'''
+::::* Preferred regimen (1): [[Cefazolin]] 2 g IV q8h for 2–4 weeks, {{then}} PO to complete 6–8 weeks
+::::* Preferred regimen (2): [[Nafcillin]] 2 g IV q4h for 2–4 weeks, {{then}} PO to complete 6–8 weeks
+::::* Preferred regimen (3): [[Oxacillin]] 2 g IV q4h for 2–4 weeks, {{then}} PO to complete 6–8 weeks
+::::* Alternative regimen: [[Clindamycin]] 600 mg IV q6h for 2–4 weeks, {{then}} PO to complete 6–8 weeks
+:::* 6.3 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
+::::* 6.3.1 '''In adults'''
+:::::* Preferred regimen: [[Vancomycin]] loading dose 25–30 mg/kg IV {{then}} [[Vancomycin]] 15–20 mg/kg IV q8–12h for 2–4 weeks, {{then}} PO to complete 6–8 weeks
+:::::* Alternative regimen (1): [[Linezolid]] 600 mg PO/IV q12h for 4–6 weeks
+:::::* Alternative regimen (2): [[Trimethoprim-Sulfamethoxazole]] 5 mg/kg PO/IV q8–12h for 4–6 weeks
+::::* 6.3.2 '''Pediatric dose'''
+:::::* Preferred regimen (1): [[Vancomycin]] 15 mg/kg IV q6h
+:::::* Preferred regimen (2): [[Linezolid]] 10 mg/kg PO/IV q8h
+:::::* Note: Consider the addition of [[Rifampin]] 600 mg qd or 300–450 mg bid to [[Vancomycin]] in adult patients..
+::* 7. ''' Bacterial meningitis'''
+:::* 7.1 '''Methicillin susceptible Staphylococcus aureus (MSSA)'''
+::::* Preferred regimen (1): [[Nafcillin]] 9–12 g/day IV q4h
+::::* Preferred regimen (2): [[Oxacillin]] 9–12 g/day IV q4h
+::::* Alternative regimen (1): [[Vancomycin]] 30–45 mg/kg/day IV q8–12h
+::::* Alternative regimen (2): [[Meropenem]] 6 g/day IV q8h
+:::* 7.2 '''Methicillin resistant Staphylococcus aureus (MRSA)'''
+::::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h
+::::* Alternative regimen (1): [[Trimethoprim-Sulfamethoxazole]] 10–20 mg/kg/day q6–12h
+::::* Alternative regimen (2): [[Linezolid]] 600 mg IV q12h
+::::* Note: Consider the addition of [[Rifampin]] 600 mg qd or 300–450 mg bid to [[Vancomycin]] in adult patients.
+::* 8. '''Septic thrombosis of cavernous or dural venous sinus'''<ref>{{Cite journal| doi = 10.1093/cid/ciq146| issn = 1537-6591| volume = 52| issue = 3| pages = –18-55| last1 = Liu| first1 = Catherine| last2 = Bayer| first2 = Arnold| last3 = Cosgrove| first3 = Sara E.| last4 = Daum| first4 = Robert S.| last5 = Fridkin| first5 = Scott K.| last6 = Gorwitz| first6 = Rachel J.| last7 = Kaplan| first7 = Sheldon L.| last8 = Karchmer| first8 = Adolf W.| last9 = Levine| first9 = Donald P.| last10 = Murray| first10 = Barbara E.| last11 = J Rybak| first11 = Michael| last12 = Talan| first12 = David A.| last13 = Chambers| first13 = Henry F.| last14 = Infectious Diseases Society of America| title = Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2011-02-01| pmid = 21208910}}</ref>
+:::* 8.1 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
+::::* 8.1.1 '''In adults'''
+:::::* Preferred regimen: [[Vancomycin]] 15–20 mg/kg IV q8–12h for 4–6 weeks
+:::::* Alternative regimen (1): [[Linezolid]] 600 mg PO/IV q12h for 4–6 weeks
+:::::* Alternative regimen (2): [[Trimethoprim-Sulfamethoxazole]] 5 mg/kg/dose PO/IV q8–12h for 4–6 weeks
+::::* 8.1.2 '''Pediatric dose'''
+:::::* Preferred regimen (1): [[Vancomycin]] 15 mg/kg IV q6h
+:::::* Preferred regimen (2): [[Linezolid]] 10 mg/kg PO/IV q8h
+:::::* Note (1): Surgical evaluation for incision and drainage of contiguous sites of infection or abscess is recommended whenever possible.
+:::::* Note (2): Consider the addition of [[Rifampin]] 600 mg qd or 300–450 mg bid to [[Vancomycin]].
+::* 9. '''Subdural empyema'''
+:::* 9.1 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''<ref>{{Cite journal| doi = 10.1093/cid/ciq146| issn = 1537-6591| volume = 52| issue = 3| pages = –18-55| last1 = Liu| first1 = Catherine| last2 = Bayer| first2 = Arnold| last3 = Cosgrove| first3 = Sara E.| last4 = Daum| first4 = Robert S.| last5 = Fridkin| first5 = Scott K.| last6 = Gorwitz| first6 = Rachel J.| last7 = Kaplan| first7 = Sheldon L.| last8 = Karchmer| first8 = Adolf W.| last9 = Levine| first9 = Donald P.| last10 = Murray| first10 = Barbara E.| last11 = J Rybak| first11 = Michael| last12 = Talan| first12 = David A.| last13 = Chambers| first13 = Henry F.| last14 = Infectious Diseases Society of America| title = Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2011-02-01| pmid = 21208910}}</ref>
+::::* 9.1.1 '''In adults'''
+:::::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h for 4–6 weeks
+:::::* Alternative regimen (1): [[Linezolid]] 600 mg PO/IV q12h for 4–6 weeks
+:::::* Alternative regimen (2): [[Trimethoprim-Sulfamethoxazole]] 5 mg/kg PO/IV q8–12h for 4–6 weeks
+::::* 9.1.2 '''In children'''
+:::::* Preferred regimen (1): [[Vancomycin]] 15 mg/kg IV q6h
+:::::* Preferred regimen (2): [[Linezolid]] 10 mg/kg PO/IV q8h
+:::::* Note: Consider the addition of [[Rifampin]] 600 mg qd or 300–450 mg bid to [[Vancomycin]].
+::* 10. ''' Acute conjunctivitis'''<ref>{{Cite journal| doi = 10.1001/jama.2013.280318| issn = 1538-3598| volume = 310| issue = 16| pages = 1721–1729| last1 = Azari| first1 = Amir A.| last2 = Barney| first2 = Neal P.| title = Conjunctivitis: a systematic review of diagnosis and treatment| journal = JAMA| date = 2013-10-23| pmid = 24150468| pmc = PMC4049531}}</ref>
+:::* 10.1 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
+::::* Preferred regimen: [[Vancomycin]] ointment 1% qid
+::* 11. '''Appendicitis'''
+:::* 11.1 '''Health care–associated complicated intra-abdominal infection'''<ref name="pmid20034345">{{cite journal| author=Solomkin JS, Mazuski JE, Bradley JS, Rodvold KA, Goldstein EJ, Baron EJ et al.| title=Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2010 | volume= 50 | issue= 2 | pages= 133-64 | pmid=20034345 | doi=10.1086/649554 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20034345  }} </ref>
+::::* 11.1.1 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
+:::::* Preferred regimen: [[Vancomycin]] 15–20 mg/kg IV q8–12h
+::* 12. '''Diverticulitis'''
+:::* 12.1 '''Health care–associated complicated intra-abdominal infection'''<ref name="pmid20034345">{{cite journal| author=Solomkin JS, Mazuski JE, Bradley JS, Rodvold KA, Goldstein EJ, Baron EJ et al.| title=Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2010 | volume= 50 | issue= 2 | pages= 133-64 | pmid=20034345 | doi=10.1086/649554 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20034345  }} </ref>
+::::* 12.1.1 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
+:::::* Preferred regimen: [[Vancomycin]] 15–20 mg/kg IV q8–12h.
+::* 13. '''Peritonitis secondary to bowel perforation, peritonitis secondary to ruptured appendix, peritonitis secondary to ruptured  appendix, typhlitis'''
+:::* 13.1 '''Health care–associated complicated intra-abdominal infection'''<ref name="pmid20034345">{{cite journal| author=Solomkin JS, Mazuski JE, Bradley JS, Rodvold KA, Goldstein EJ, Baron EJ et al.| title=Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2010 | volume= 50 | issue= 2 | pages= 133-64 | pmid=20034345 | doi=10.1086/649554 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20034345  }} </ref>
+::::* 13.1.1 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
+:::::* Preferred regimen: [[Vancomycin]] 15–20 mg/kg IV q8–12h
+::* 14. '''Cystic fibrosis'''<ref name="pmid23540878">{{cite journal| author=Mogayzel PJ, Naureckas ET, Robinson KA, Mueller G, Hadjiliadis D, Hoag JB et al.| title=Cystic fibrosis pulmonary guidelines. Chronic medications for maintenance of lung health. | journal=Am J Respir Crit Care Med | year= 2013 | volume= 187 | issue= 7 | pages= 680-9 | pmid=23540878 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23540878  }} </ref>
+:::* 14.1 '''Adults'''
+::::* 14.1.1 '''If methicillin sensitive staphylococcus aureus'''
+:::::* Preferred Regimen (1): [[Nafcillin]] 2 gm IV q4h
+:::::* Preferred Regimen (2): [[Oxacillin]] 2 gm IV q4h
+::::* 14.1.2 '''If methicillin resistant staphylococcus aureus'''
+:::::* Preferred Regimen (1): [[Vancomycin]] 15-20 mg/kg IV q8-12h
+:::::* Preferred Regimen (2): [[Linezolid]] 600 mg PO/IV q12h
+:::* 14.2 '''Pediatric'''
+::::* 14.2.1 '''If methicillin sensitive staphylococcus aureus'''
+:::::* Preferred Regimen (1): [[Nafcillin]] 5 mg/kg q6h (Age >28 days)
+:::::* Preferred Regimen (2): [[Oxacillin]] 75 mg/kg q6h (Age >28 days)
+::::* 14.2.2 '''If methicillin resistant staphylococcus aureus'''
+:::::* Preferred Regimen (1): [[Vancomycin]] 40 mg/kg  q6-8h (Age >28 days)
+:::::* Preferred Regimen (2): [[Linezolid]] 10 mg/kg PO/IV q8h (up to age 12)
+::* 15. '''Bronchiectasis'''<ref name="pmid20627931">{{cite journal| author=Pasteur MC, Bilton D, Hill AT, British Thoracic Society Bronchiectasis non-CF Guideline Group| title=British Thoracic Society guideline for non-CF bronchiectasis. | journal=Thorax | year= 2010 | volume= 65 Suppl 1 | issue=  | pages= i1-58 | pmid=20627931 | doi=10.1136/thx.2010.136119 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20627931  }} </ref>
+:::* 15.1 '''In adults'''
+::::* 15.1.1 '''Recommended first-line treatment and length of treatment'''
+:::::* 15.1.1.1 '''Methicillin-susceptible Staphylococcus aureus (MSSA)'''
+::::::* Preferred regimen: [[Flucloxacillin]] 500 mg PO qds for 14 days
+:::::* 15.1.1.2  '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
+::::::* '''Patient's body weight is < 50 kg'''
+:::::::* Preferred regimen: [[Rifampicin]] 450 mg PO qd {{and}} [[Trimethoprim]] 200 mg PO bd for 14 days
+::::::* '''Patient's body weight is > 50 kg'''
+:::::::* Preferred regimen: [[Rifampicin]] 600 mg PO qd {{and}} [[Trimethoprim]] 200 mg PO bd for 14 days
+:::::* 15.1.1.3 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
+::::::* Preferred regimen (1): [[Vancomycin]] 1 g IV bd (monitor serum levels and adjust dose accordingly)
+::::::* Preferred regimen (2): [[Teicoplanin]] 400 mg qd for 14 days
+::::* 15.1.2 '''Recommended second-line treatment and length of treatment'''
+:::::* 15.1.2.1 '''Methicillin-susceptible Staphylococcus aureus (MSSA)'''
+::::::* Preferred regimen: [[Clarithromycin]] 500 mg PO bd 14 days
+:::::* 15.1.2.2 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
+::::::* '''Patient's body weight is < 50 kg '''
+:::::::* Preferred regimen: [[Rifampicin]] 450 mg PO qd {{and}} [[Doxycycline]] 200 mg PO qd for 14 days
+::::::* '''Patient's body weight is > 50 kg'''
+:::::::* Preferred regimen: [[Rifampicin]] 600 mg PO qd {{and}} [[Doxycycline]] 200 mg PO qd for 14 days
+::::::* '''Third-line''': [[Linezolid]] 600 mg bd for 14 days
+:::::* 15.1.2.3 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
+::::::* Preferred regimen: [[Linezolid]] 600 mg IV bd for 14 days
+:::* 15.2 '''In children'''
+::::* 15.2.1 '''Recommended first-line treatment and length of treatment'''
+:::::* 15.2.1.1 '''Methicillin-susceptible Staphylococcus aureus (MSSA)'''
+::::::* Preferred regimen: [[Flucloxacillin]]
+:::::* 15.2.1.2 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
+::::::* 15.2.1.2.1 '''Children''' (< 12 yr)
+:::::::* Preferred regimen: [[Trimethoprim]] 4-6 mg/kg/day PO q12h
+::::::* 15.2.1.2.2 '''Children''' (> 12 yr)
+:::::::* Preferred regimen (1): [[Trimethoprim]] 100-200 mg PO q12h
+:::::::* Preferred regimen (2): [[Rifampicin]] 450 mg PO od (or [[Rifampicin]] 600 mg PO od)
+:::::* 15.2.1.3 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
+::::::* Preferred regimen (1): [[Vancomycin]] 45-60 mg/kg/day IV q8-12h
+::::::* Preferred regimen (2): [[Teicoplanin]] 400 mg qd for 14 days
+::::* 15.2.2 '''Recommended second-line treatment and length of treatment'''
+:::::* 15.2.2.1 '''Methicillin-susceptible Staphylococcus aureus (MSSA)'''
+::::::* Preferred regimen: [[Clarithromycin]] 15 mg/kg/day PO q12h
+:::::* 15.2.2.2 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
+::::::* Preferred regimen (1): [[Rifampicin]] {{and}} [[Doxycycline]] 2-5 mg/kg/day PO/IV q12-24h  (max dose: 200 mg/24 hr)
+::::::* Preferred regimen (2): [[Rifampicin]] {{and}} [[Doxycycline]] 2-5 mg/kg/day PO/IV q12-24h  (max dose: 200 mg/24 hr)
+::::::* '''Third-line''': [[Linezolid]] 10 mg/kg PO/IV q12h
+:::::* 15.2.2.3 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
+::::::* Preferred regimen: [[Linezolid]] 10 mg/kg PO/IV q12h
+:::*  15.3 '''Long-term oral antibiotic treatment'''
+::::* 15.3.1 '''In adults'''
+:::::* 15.3.1.1 '''Recommended first-line treatment and length of treatment'''
+::::::* 15.3.1.1.1 '''Methicillin-susceptible Staphylococcus aureus (MSSA)'''
+:::::::* Preferred regimen: [[Flucloxacillin]] 500 mg PO bd
+:::::* 15.3.1.2 '''Recommended second-line treatment and length of treatment'''
+::::::* 15.3.1.2.1 '''Methicillin-susceptible Staphylococcus aureus (MSSA)'''
+:::::::* Preferred regimen: [[Clarithromycin]] 250 mg PO bd
+::* 16. '''Empyema'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
+:::* Preferred regimen (1): [[Nafcillin]]  2 gm IV q4h
+:::* Preferred regimen (2): [[oxacillin]]  2 gm IV q4h (if MSSA)
+:::* Alternative regimen (1): [[Vancomycin]]  1 gm IV q12h
+:::* Alternative regimen (2): [[Linezolid]]  600 mg PO bid (if MRSA)
+::* 17. '''Community-acquired pneumonia'''<ref name="pmid17278083">{{cite journal| author=Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC et al.| title=Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. | journal=Clin Infect Dis | year= 2007 | volume= 44 Suppl 2 | issue=  | pages= S27-72 | pmid=17278083 | doi=10.1086/511159 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17278083  }} </ref>
+:::* 17.1 '''Methicillin-susceptible Staphylococcus aureus (MSSA)'''
+::::* Preferred Regimen (1): [[Nafcillin]] 1000-2000 mg q4h
+::::* Preferred Regimen (2): [[Oxacillin]] 2 g IV q4h
+::::* Preferred Regimen (3): [[Flucloxacillin]] 250 mg IM/IV q6h
+::::* Alternative Regimen (1): [[Cefazolin]] 500 mg IV q12h
+::::* Alternative Regimen (2): [[Clindamycin]] 150-450 mg PO q6-8h
+:::* 17.2 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
+::::* Preferred Regimen (1): [[Vancomycin]] 45-60 mg/kg/day q8-12h (max: 2000 mg/dose) for 7-21 days
+::::* Preferred Regimen (2): [[Linezolid]] 600 mg PO/IV q12h for 10-14 days
+::::* Alternative Regimen: [[Trimethoprim-Sulfamethoxazole]] 1-2 double-strength tablets (800/160 mg) q12-24h
+::* 18. '''Olecranon bursitis or prepatellar bursitis'''
+:::* 18.1 '''Methicillin-susceptible Staphylococcus aureus (MSSA)'''
+::::* Preferred regimen (1): [[Nafcillin]] 2 g IV q4h
+::::* Preferred regimen (2): [[Oxacillin]] 2 g IV q4h
+::::* Preferred regimen (3): [[Dicloxacillin]] 500 mg PO qid
+:::* 18.2 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
+::::* Preferred regimen (1): [[Vancomycin]] 1 g IV q12h
+::::* Preferred regimen (2): [[Linezolid]] 600 mg PO qd
+::::* Note: Initially aspirate q24h and treat for a minimum of 2–3 weeks.
+::* 19. '''Septic arthritis'''
+:::* 19.1 '''In adults'''
+::::* 19.1.1 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
+:::::* Preferred regimen: [[Vancomycin]] 15–20 mg/kg IV q8–12h
+:::::* Alternative regimen (1): [[Daptomycin]] 6 mg/kg IV q24h in adults
+:::::* Alternative regimen (2): [[Linezolid]] 600 mg PO/IV q12h
+:::::* Alternative regimen (3): [[Clindamycin]] 600 mg PO/IV q8h
+:::::* Alternative regimen (4): TMP-SMX 3.5–4.0 mg/kg PO/IV q8–12h
+::::* 19.2.1 '''Methicillin-susceptible Staphylococcus aureus (MSSA)'''
+:::::* Preferred regimen (1): [[Nafcillin]] 2 g IV q6h
+:::::* Preferred regimen (2): [[Clindamycin]] 900 mg IV q8h
+:::::* Alternative regimen (1): [[Cefazolin]] 0.25–1 g IV/IM q6–8h
+:::::* Alternative regimen (2): [[Vancomycin]] 500 mg IV q6h or 1 g IV q12h
+:::* 19.2 '''In childern'''
+::::* Preferred regimen (1): [[Vancomycin]] 15 mg/kg IV q6h
+::::* Preferred regimen (2): [[Daptomycin]] 6–10 mg/kg IV q24h
+::::* Preferred regimen (3): [[Linezolid]] 10 mg/kg PO/IV q8h
+::::* Preferred regimen (4): [[Clindamycin]] 10–13 mg/kg PO/IV q6–8h
+::* 20. '''Septic arthritis, prosthetic joint infection (device-related osteoarticular infections)'''
+:::* 20.1 ''' Methicillin-susceptible Staphylococcus aureus (MSSA)'''
+::::* Preferred regimen (1): [[Nafcillin]] 2 g IV q4–6h
+::::* Preferred regimen (2): [[Oxacillin]] 2 g IV q4–6h
+::::* Alternative regimen (1): [[Cefazolin]] 1–2 g IV q8h
+::::* Alternative regimen (2): [[Ceftriaxone]] 2 g IV q24h
+::::* Alternative regimen (if allergic to penicillins) (3): [[Clindamycin]] 900 mg IV q8h
+::::* Alternative regimen (if allergic to penicillins) (4): [[Vancomycin]] 15–20 mg/kg IV q8–12h, (max: 2 g per dose)
+:::* 20.2 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
+::::* Early-onset (2 months after surgery) or acute hematogenous prosthetic joint infections involving a stable implant with short duration (< 3 weeks) of symptoms and debridement (but device retention)
+::::* Preferred regimen: [[Vancomycin]] {{and}} [[Rifampin]] 600 mg PO qd or 300–450 mg PO bid for 2 weeks
+::::* Alternative regimen (1): [[Daptomycin]] 6 mg/kg IV q24h {{and}} [[Rifampin]] 600 mg PO qd or 300–450 mg PO bid for 2 weeks
+::::* Alternative regimen (2): [[Linezolid]] 600 IV q8h {{and}} [[Rifampin]] 600 mg PO qd or 300–450 mg PO bid for 2 weeks
+::::* Note: The above regimen should be followed by [[Rifampin]] and a [[Fluoroquinolone]], TMP/SMX, a [[Tetracycline]] or [[Clindamycin]] for 3-6 months for hips and knees, respectively.
+::* 21. '''Hematogenous osteomyelitis'''
+:::* 21.1 '''Adult''' (> 21 yrs)
+::::* 21.1.1 '''Methicillin-resistant Staphylococcus aureus (MRSA)''' possible
+:::::* Preferred regimen: [[Vancomycin]] 1 gm IV q12h (if over 100 kg, 1.5 gm IV q12h)
+::::* 21.1.2 '''Methicillin-resistant Staphylococcus aureus (MRSA)''' unlikely
+:::::* Preferred regimen (1): [[Nafcillin]]
+:::::* Preferred regimen (2): [[Oxacillin]] 2 gm IV q4h
+:::* 21.2 '''Children''' (> 4 months)-Adult
+::::* 21.2.1 '''Methicillin-resistant Staphylococcus aureus (MRSA)''' possible
+:::::* Preferred regimen: [[Vancomycin]] 40 mg IV q6–8h
+::::* 21.2.2 '''Methicillin-resistant Staphylococcus aureus (MRSA)''' unlikely
+:::::* Preferred regimen (1): [[Nafcillin]]
+:::::* Preferred regimen (2): [[Oxacillin]] q6h (max. 8–12 gm per day)
+:::::* Note: Add [[Ceftazidime]] 50 mg q8h or [[Cefepime]] 150 mg q8h if Gram negative bacilli on Gram stain
+:::* 21.3 '''Newborn''' (< 4 months.)
+::::* 21.3.1 '''Methicillin-resistant Staphylococcus aureus (MRSA)''' possible
+:::::* Preferred regimen (1): [[Vancomycin]] {{and}} [[Ceftazidime]] 2 gm IV q8h
+:::::* Preferred regimen (2): [[Vancomycin]] {{and}} [[Cefepime]] 2 gm IV q12h
+::::* 21.3.2 '''Methicillin-resistant Staphylococcus aureus (MRSA)''' unlikely
+:::::* Preferred regimen (1): [[Nafcillin]]  {{and}} [[Ceftazidime]]
+:::::* Preferred regimen (2): [[Oxacillin]] {{and}} [[Cefepime]]
+:::* 21.4 '''Specific therapy'''
+::::* 21.4.1 ''' Methicillin-susceptible Staphylococcus aureus (MSSA)'''
+:::::* Preferred regimen (1): [[Nafcillin]]
+:::::* Preferred regimen (2): [[Oxacillin]] 2 gm IV q4h
+:::::* Preferred regimen (3): [[Cefazolin]] 2 gm IV q8h
+:::::* Alternative regimen: [[Vancomycin]] 1 gm IV q12h (if over 100 kg, 1.5 gm IV q12h)
+::::* 21.4.2 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
+:::::* Preferred regimen: [[Vancomycin]] 1 gm IV q12h
+:::::* Alternative regimen: [[Linezolid]] 600 mg q12h PO/IV with or without [[Rifampin]] 300 mg PO/IV bid
+::* 22. '''Diabetic foot osteomyelitis'''
+:::* High risk for MRSA
+::::* Preferred regimen (1): [[Linezolid]] 600 mg IV or PO q12h
+::::* Preferred regimen (2): [[Daptomycin]] 4 mg/kg IV q24h
+::::* Preferred regimen (3): [[Vancomycin]] 15–20 mg/kg IV q8–12h (trough: 10–20 mg/L)
+::* 23. ''' Necrotizing fasciitis'''<ref name="pmid24947530">{{cite journal| author=Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL et al.| title=Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America. | journal=Clin Infect Dis | year= 2014 | volume= 59 | issue= 2 | pages= 147-59 | pmid=24947530 | doi=10.1093/cid/ciu296 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24947530  }} </ref>
+:::* 23.1 '''In adult'''
+::::* Preferred regimen (1): [[Nafcillin]] 1–2 g IV  q4h (severe Pencillin allergy: [[Vancomycin]], [[linezolid]], [[quinupristin]]/[[dalfopristin]], daptomycin)
+::::* Preferred regimen (2): [[Oxacillin]] 1–2 g IV  q4h
+::::* Preferred regimen (3): [[Cefazolin]] 1 g IV  q8h
+::::* Preferred regimen (4): [[Vancomycin]] 15 mg/kg IV bid
+::::* Preferred regimen (5): [[Clindamycin]] 600–900 mg IV  q8h
+:::* 23.2 '''In childern'''
+::::* Preferred regimen (1): [[Nafcillin]] 50 mg/kg/dose IV  q6h  (severe Pencillin allergy: [[Vancomycin]], [[linezolid]], [[quinupristin]]/[[dalfopristin]], [[daptomycin]])
+::::* Preferred regimen (2): [[Oxacillin]] 50 mg/kg/dose IV q6h
+::::* Preferred regimen (3): [[Cefazolin]] 33 mg/kg/dose IV q8h
+::::* Preferred regimen (4): [[Vancomycin]] 15 mg/kg/dose IV q6h
+::::* Preferred regimen (5): [[Clindamycin]] 10–13 mg/kg/dose IV q8h  ([[Bacteriostatic]]; potential cross-resistance and emergence of resistance in [[erythromycin]]-resistant strains; inducible resistance in methicillin resistent staphylococcus aureus)
+::* 24. '''Staphylococcal toxic shock syndrome'''<ref name="pmid19393958">{{cite journal| author=Lappin E, Ferguson AJ| title=Gram-positive toxic shock syndromes. | journal=Lancet Infect Dis | year= 2009 | volume= 9 | issue= 5 | pages= 281-90 | pmid=19393958 | doi=10.1016/S1473-3099(09)70066-0 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19393958  }} </ref>
+:::* 24.1 '''Methicillin sensitive Staphylococcus aureus'''
+::::* Preferred regimen (1): [[Cloxacillin]]  250-500 mg PO q6h (max dose: 4 g/24 hr)
+::::* Preferred regimen (2): [[Nafcillin]]  4-12 g/24 hr IV q4-6hr (max dose: 12 g/24 hr)
+::::* Preferred regimen (3): [[Cefazolin]] 0.5-2g IV/IM q8h (max dose: 12 g/24 hr) {{and}} [[Clindamycin]] 150-600 mg IV, IM/PO q6-8h  (max dose: 5 g/24 hr IV or IM or 2 g/24 hr PO)
+::::* Alternative regimen (1): [[Clarithromycin]] 250-500 mg PO q12h (max dose: 1 g/24 hr) {{and}} [[Clindamycin]] 150-600 mg IV, IM/PO q6-8h  (max dose: 5 g/24 hr IV/IM or 2 g/24h PO)
+::::* Alternative regimen (2): [[Rifampicin]] {{and}} [[Linezolid]] 600 mg IV/PO q12h
+::::* Alternative regimen (3): [[Daptomycin]]
+::::* Alternative regimen (4): [[Tigecycline]] 100 mg loading dose {{then}} 50 mg IV q12h
+:::* 24.2 '''Methicillin resistant Staphylococcus  aureus'''
+::::* Preferred regimen (1): [[Clindamycin]] 150-600 mg IV, IM/PO q6-8h (max dose: 5 g/24h IV/IM or 2 g/24h PO)
+::::* Preferred regimen (2): [[Linezolid]] 600 mg IV/PO q12h {{and}} [[Vancomycin]] 15-20 mg/kg IV q8-12h, (max: 2 g per dose)
+::::* Preferred regimen (3): [[Teicoplanin]]
+::::* Alternative regimen (1): [[Rifampicin]] {{and}} [[Linezolid]] 600 mg IV/PO q12h
+::::* Alternative regimen (2): [[Daptomycin]]
+::::* Alternative regimen (3): [[Tigecycline]] 100 mg loading dose {{then}} 50 mg IV q12h
+:::* 24.3 '''Glycopeptide resistant or intermediate Staphylococcus aureus'''
+::::* Preferred regimen: [[Linezolid]] 600 mg IV/PO q12h {{and}} [[Clindamycin]] 150-600 mg IV, IM/PO q6-8h (max dose: 5 g/24 hr IV/IM or 2 g/24h PO) (if sensitive)
+::::* Alternative regimen (1): [[Daptomycin]]
+::::* Alternative regimen (2): [[Tigecycline]] 100 mg loading dose {{then}} 50 mg IV q12h
 ==References==
@@ Line 8: / Line 461: @@
 [[Category:Disease]]
 [[Category:Infectious diseases]]
+[[Category:Infectious Disease Project]]