Table 2.

Treatment Options for S. aureus and MRSA Osteomyelitis

Antimicrobial Agent	Route	Active for MRSA?	Evidence for Effectiveness					Comments
			Animal Studies	Case Report	Case Series	Clinical Trial*	RCT†
IV, intravenous.
Nafcillin	IV	No	X	X	X	X	X	MSSA drug of choice
Cefazolin	IV	No	X	X	X	X	X	MSSA drug of choice
Ceftriaxone	IV	No	X	X	X	X	X	Probably comparable with nafcillin
Vancomycin	IV	Yes	X	X	X	X	X	MRSA drug of choice
Teicoplanin‡	IV	Yes	X	X	X	X	X	Similar to vancomycin
Linezolid	Oral, IV	Yes	X	X	X	X		? Comparable with vancomycin
Fluoroquinolone§	Oral, IV	Some¶	X	X	X	X	X	? Need for combination Rx especially for MRSA
Daptomycin	IV	Yes	X	X	X			Limited data
Clindamycin	Oral, IV	Some¶	X	X	X	X	X	? Comparable with nafcillin
Trimethoprim-sulfamethoxazole	Oral, IV	Most strains	X	X	X	X	X	Data mostly for device infections
Minocycline	Oral	Most strains		X	X	X		Limited data
Tigecycline	IV	Yes	X	X				Insufficient data
Quinupristin-dalfopristin	IV	Most strains	X	X	X			Limited data
Fusidic acid‡	Oral	Most strains	X	X	X	X		Use in combination therapy only
Rifampin	Oral, IV	Yes	X	X	X	X	X	Use in combination therapy only

^*Therapeutic trial or prospective case series.

^†Randomized clinical trial.

^‡Not available in the United States.

^§Includes ciprofloxacin, ofloxacin, levofloxacin, moxifloxacin, gemifloxacin though potency versus S. aureus may vary.

^¶Usually only community-associated MRSA strains still susceptible.