Table 2.
Antimicrobial Agent(s) for the Treatment of Suspected or Proven Methicillin-resistant Staphylococcus aureus (MRSA) Infections
| I. Initial Empiric Therapy (Staphylococcus aureus of unknown susceptibility) | ||
|---|---|---|
| Drugs of choice: | Vancomycin + nafcillin or oxacillin + gentamicin | For life-threatening infections; Linezolid could be substituted for vancomycin if several recent courses with vancomycin |
| Nafcillin or oxacillin | For nonlife-threatening infections when community MRSA rates are low | |
| Clindamycin | For nonlife-threatening infections when MRSA rates are high and clindamycin resistance is low | |
| Vancomycin | For nonlife-threatening infections when MRSA rates are high and clindamycin resistance is high | |
|
| ||
|
II. MRSA Therapy (oxacillin MIC, 4 micrograms/milliliter or greater)
| ||
| A. Healthcare-Associated MRSA (Multi-drug Resistant)
| ||
| Drugs of choice: | Vancomycin ± gentamicin ± rifampin | |
| Alternatives: (susceptibility results before alternative drugs used) | Trimethoprim-sulfamethoxazole Linezolid Quinupristin-dalfopristin Fluoroquinolones |
Not recommended < 18 years |
|
| ||
| B. Community-Associated MRSA (Not Multi-drug Resistant)
| ||
| Drugs of choice: | Vancomycin ± gentamicin (or ± rifampin) Clindamycin (if susceptible) Trimethoprim-sulfamethoxazole |
For life-threatening infections For pneumonia, septic arthritis, osteomyelitis, or skin infections For skin or soft tissue infection |
| Alternatives: | Vancomycin | |
*
Adapted with permission from American Academy of Pediatrics(39).