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IV/PO Antibiotics: MRSA - #PHARMFAX

MRSA in the blood stream is an independent predictor of mortality.


MRSA in the blood stream is an independent predictor of mortality. Methicillin-resistant staphylcoccus aureus (MRSA) has a become a common pathogen in the community, and known as a nosocomial organism looking for high risk patients. Oral options are available IV and their difference in drug classes provides alternatives for true allergies.

These include sulfamethoxazole-trimethoprim, doxycycline, linezolid, and clindamycin. Oral vancomycin is indicated only for Clostridium difficile. Keep in mind safety pearls. Bactrim can cause AKI and hyperkalemia. Doxycycline gets you sunburnt, but at least its not renally metabolized. Linezolid develops thrombocytopenia with prolonged use, Clindamycin has limited uses with high resistance and association with C. diff.

It amazes me how vancomycin remains an effective first-line agent for MRSA. Vancomycin flushing syndrome is the new term, but nephrotoxicity isn’t. Daptomycin provides once daily dosing. It does cause rhabdomylosis and

Ceftaroline is the only beta-lactam indicated for MRSA. Its a newer generation than cefepime, but lacks pseudomonas coverage. Ortivancin and dalbavancin are fairly recent, and provide one time dosing for skin infections. Your local antibiogram determines the best agent. Hungry for the PHARMFAX? Check out my website at, and I hope you learned something new.

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