Table 3.

Treatment recommendations for MRSA bacteremia

Condition	IDSA [8]	ESCMID/ISC/ESC [59, 60, 62, 63]
Uncomplicated bacteremia	Vancomycin or daptomycin 6 mg/kg/dose IV once daily for 2 weeks	Vancomycin doses to trough plasma concentration of 15–20 mg/L or teicoplanin if nephrotoxicity is a concern (daptomycin if vancomycin is poorly tolerated) for 10–14 days Consider switching to linezolid PO in patients with a rapid response and negative cultures after catheter removal
Complicated bacteremia	Vancomycin or daptomycin 6 mg/kg/dose IV once daily for 4–6 weeks, depending on extent of infection	Vancomycin, but switch to daptomycin if there is poor response or use daptomycin first-line in patients with life-threatening infection, renal impairment, previous glycopeptide use, or vancomycin resistance or reduced susceptibility Treat for 4–6 weeks
Infective endocarditis, native valve	Vancomycin or daptomycin 6 mg/kg/dose IV once daily for 6 weeks	Vancomycin 30–60 mg/kg/day IV in 2–3 doses for 4–6 weeks Alternative therapies: daptomycin 10 mg/kg/day IV once daily for 4–6 weeks or TMP/SMX + clindamycin
Infective endocarditis, prosthetic valve	Vancomycin IV + rifampin 300 mg PO/IV for ≥6 weeks + gentamicin 1 mg/kg/dose IV q8h for 2 weeks	Vancomycin 30–60 mg/kg/day IV in 2–3 doses for ≥6 weeks + rifampin 900–1200 mg IV or orally in  2–3 doses for ≥6 weeks and gentamicin 3/mg/kg/day IV or IM in 1–2 doses for 2 weeks
Infective endocarditis, right-sided		Vancomycin 15 mg/kg q12h for 6 weeks or daptomycin ≥6 mg/kg/day for 4–6 weeks if patient has renal impairment, sustained bacteremia for >7 days, infection with a VISA strain Optional addition of short-term gentamicin to vancomycin Alternative option: vancomycin + rifampin
Infective endocarditis, left-sided		Vancomycin 15 mg/kg q12h for 4–6 weeks with early and careful attention to culture results Switch to high-dose daptomycin (10 mg/kg/day) if no response to vancomycin and isolate is susceptible Optional addition of short-term gentamicin to vancomycin Alternative option: vancomycin + rifampin
Persistent bacteremia, despite vancomycin treatment	If isolate is susceptible, high-dose daptomycin (10 mg/kg/day) + another agenta If isolate has reduced susceptibility to vancomycin and daptomycin, options for monotherapy or combination therapy are quinupristin/dalfopristin 7.5 mg/kg/dose IV q8h, linezolid 600 mg PO/IV bid, or telavancin 10 mg/kg/dose IV od	Daptomycin 10 mg/kg/day if isolates susceptible, possibly in combination with another agent (e.g., gentamicin, rifampicin, linezolid, a beta-lactam, or trimethoprim-sulfamethoxazole) Options for agents with reduced susceptibility to daptomycin or vancomycin, including quinupristin/dalfopristin, linezolid, or telavancin

Adapted from US and International guidelines and recommendations found in Garau et al. [60], Gould et al. 2011 [59], Gould et al. 2012 [62], Habib et al. [63], and Liu et al. [8]

^aOptions include gentamicin 1 mg/kg IV q8h, rifampin 600 mg PO/IV daily or 300–450 mg PO/IV bid, linezolid 600 mg PO/IV bid, trimethoprim-sulfamethoxazole 5 mg/kg IV bid, or a beta-lactam antibiotic

Abbreviations: bid twice daily, ESC European Society of Cardiology, ESCMID European Society of Clinical Microbiology and Infectious Diseases, IDSA Infectious Disease Society of America, ISC International Society of Chemotherapy, IM intramuscular, IV intravenous, MRSA methicillin-resistant S. aureus, od once daily, PO orally, q8h/q12h every 8/12 h, TMP/SMX trimethoprim/sulfamethoxazole, VISA vancomycin-intermediate S. aureus