Choose a single article, issue, or full-access subscription. Guideline source: Infectious Diseases Society of America, Published source: Clinical Infectious Diseases, February 1, 2011, Available at: http://cid.oxfordjournals.org/content/early/2011/01/04/cid.ciq146.full. Clindamycin 900 mg IV q8h - S. aureus: Antistaphyloccal penicillin/cephalosporin for MSSA or Vancomycin for MRSA § Type III – Clostridial (C. perfringens, rarely . MRSA Snapshot. The optimal route of administration of antibiotic therapy has not been established; parenteral, oral, or initial parenteral therapy followed by oral therapy may be used, depending on patient circumstances. linezolid). Am Fam Physician. April 1, 2008;46(7):1032–1037. For adults with infective endocarditis, intravenous vancomycin or daptomycin (6 mg per kg intravenously once per day for six weeks) is recommended. Data regarding the safety and effectiveness of alternative agents in children are limited, although daptomycin (6 to 10 mg per kg intravenously once per day) may be an option. 9(May 1, 2009) The national clindamycin susceptibility pattern is limited to MSSA and may not have an optimal susceptibility profile suitable for use as a prophylactic antibiotic. Recommended Treatments for Community-Acquired MRSA Infections. If the patient has not responded to vancomycin therapy despite adequate debridement and removal of other foci of infection, an alternative agent is recommended. For most patients with skin and soft-tissue infections who have normal renal function and are not obese, traditional dosages of 1 g every 12 hours are adequate, and trough monitoring is not required. afpserv@aafp.org for copyright questions and/or permission requests. Clindamycin can be used for infections (eg, skin and soft-tissue infections) in communities where community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is common; whether clindamycin is useful depends on local resistance patterns. Patients with fever or other systemic symptoms are also usually treated with antimicrobial agents. However, because TMP/SMX may inadequately treat group A streptococci, combining it with another antimicrobial may be preferred when the specific organism is unknown. Antibiotic options with parenteral and oral routes of administration include the following: TMP/SMX (4 mg per kg [TMP component] twice per day) in combination with rifampin (600 mg once per day), linezolid, and clindamycin (600 mg every eight hours). A clinical assessment to identify the source and extent of the infection with elimination and/or debridement of other sites of infection is recommended. The role of anticoagulation is controversial. Strong recommendation, moderate quality of evidence. Oral antibiotic options for treating skin and soft-tissue infections in patients with community-associated MRSA include clindamycin, trimethoprim/sulfamethoxazole (TMP/SMX; Bactrim, Septra), a tetracycline (doxycycline or minocycline [Minocin]), and linezolid (Zyvox). 2) Previously infected with MRSA or P. aeruginosa. An oral agent in combination with rifampin, if the strain is susceptible, may be considered if infections recur despite these measures. A beta-lactam antibiotic (e.g., cefazolin) may be considered in hospitalized patients with nonpurulent cellulitis. Daptomycin (6 mg per kg intravenously once per day) and linezolid are alternative therapies. At home — Treatment of MRSA at home usually includes a 7- to 10-day course of an antibiotic (by mouth) such as trimethoprim-sulfamethoxazole (brand name: Bactrim), clindamycin, min… Surgical evaluation for incision and drainage of contiguous sites of infection or abscess is recommended. More complicated lesions (i.e., those with surrounding cellulitis or no drainable foci) are usually treated with antimicrobial agents. Treatment for seven to 14 days is recommended, but should be individualized to the patient's clinical response. It may be especially useful in serious skin and soft-tissue infections, such as necrotizing fasciitis, because of its ability to inhibit toxin production. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. MRSA-active therapy may be modified if there is no clinical response. Choose a single article, issue, or full-access subscription. The decision to use combination therapy should be individualized. Cephalexin and cefazolin provide coverage for group A Streptococcus and MSSA. Cultures from abscesses and other purulent infections are recommended in patients who have received antibiotic therapy, those with severe local infection or signs of systemic illness, and those who have not responded adequately to initial treatment. Cefazolin continues to have excellent coverage against MSSA. Clindamycin is widely used in children for community-acquired MRSA skin and soft-tissue infections, and is anecdotally reported to be effective. Interventions Flucloxacillin, at a minimum of 500 mg 4 times per day for 5 days, with clindamycin 300 … Without reliable ways to determine which patients need MRSA coverage, it is unclear which patients with uncomplicated cellulitis need to be discharged with MRSA coverage and which will do fine with a single agent. Immediate, unlimited access to all AFP content. In symptomatic contacts, nasal and topical body decolonization strategies may be considered after treating the active infection. Among the 42% of MRSA with discordant erythromycin/clindamycin susceptibility, iMLS was demonstrated in vitro in 50%, whereas, of the 30% of MSSA with discordant erythromycin/clindamycin susceptibility, 63% demonstrated in vitro iMLS (P =.098 for all MRSA vs. all MSSA, by χ 2 test). The mainstay of therapy for osteomyelitis is surgical debridement with drainage of associated soft-tissue abscesses. Clindamycin is widely used in children for community-acquired MRSA skin and soft-tissue infections, and is anecdotally reported to be effective. All rights Reserved. Illnesses caused by MRSA include skin and soft-tissue infections, bacteremia and endocarditis, pneumonia, bone and joint infections, central nervous system disease, and toxic shock and sepsis syndromes. Some experts recommend higher dosages of daptomycin (8 to 10 mg per kg intravenously once per day). A collection of Practice Guidelines published in AFP is available at https://www.aafp.org/afp/practguide. Treatment options for MRSA infection are limited, complicated and expensive. These may be given as a single agent or in combination with other antibiotics. The optimal duration of parenteral and oral therapy is unclear; oral therapy should be continued until spinal fusion has occurred. Linezolid may be considered as an alternative (600 mg orally or intravenously twice per day for children 12 years and older; 10 mg per kg orally or intravenously every eight hours for children younger than 12 years). The most commonly used oral antibiotic for the coverage of community-associated MRSA is trimethoprim-sulfamethoxazole. Clindamycin is an antibiotic used for the treatment of a number of bacterial infections, including bone or joint infections, pelvic inflammatory disease, strep throat, pneumonia, middle ear infections, and endocarditis. 2008;46(7):1033. Am Fam Physician. The duration of therapy may range from two to six weeks depending on the source, the presence of endovascular infection, and metastatic foci of infection. / Vol. Clin Infect Dis. 79/No. Echocardiography is recommended in children with congenital heart disease, bacteremia lasting more than two to three days, or other clinical findings suggestive of endocarditis. In vitro evidence suggests TMP/SMX has greater bactericidal activity against community-acquired MRSA than linezolid (Zyvox), rifampin (Rifadin), clindamycin (Cleocin), or minocycline (Minocin). Vancomycin is recommended in hospitalized children. Recommendations for vancomycin dosing are based on a consensus statement of the American Society of Health-System Pharmacists, the IDSA, and the Society of Infectious Diseases Pharmacists. Patients can be transitioned to oral therapy if the strain is susceptible. Clindamycin and linezolid are alternative treatments for nonendovascular infections. So it’s logical that MRSA coverage would lead to better outcomes for cellulitis. Neurosurgical evaluation for incision and drainage is recommended for patients with brain abscess, subdural empyema, or spinal epidural abscess. / afp A clinical review found response rates between 80 to 100 percent with these agents, and one small prospective trial reported a 100 percent response rate in doxycycline-treated patients after incision and drainage of MRSA abscesses. Commercially available cleaners or detergents should be used to clean high-touch surfaces (e.g., doorknobs, counters, bathtubs, toilet seats) that may come in contact with bare skin or uncovered infections. Trough vancomycin monitoring is recommended for patients with serious infections or who are morbidly obese, have renal dysfunction (including those receiving dialysis), or have fluctuating volumes of distribution. However, if local or regional CA-MRSA susceptibility data indicate that resistance to clindamycin is greater than 15%, it has been recommended to avoid using clindamycin empirically. In addition to common clinical syndromes, the guidelines address treatment with vancomycin, limitations of susceptibility testing, and alternative therapies. Empiric therapy for MRSA is recommended, pending sputum and/or blood culture results, for hospitalized patients with severe community-acquired pneumonia defined by one of the following: a requirement for admission to the intensive care unit, necrotizing or cavitary infiltrates, or empyema. Doctors use clindamycin to treat infections in people with a penicillin allergy. However, they can also cause more serious infections, including pneumonia, pelvic osteomyelitis, septic thrombophlebitis, and necrotizing fasciitis. The recommended treatment for patients with meningitis is intravenous vancomycin for two weeks. Regular bathing is advised, as well as hand washing with soap and water or an alcohol-based hand gel, especially after touching infected skin or an item that has been in contact with a draining wound. Drainage or debridement of the joint space should be performed. Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP. To see the full article, log in or purchase access. Vancomycin remains the first choice for MRSA therapy. For those with nonpurulent cellulitis, five to 10 days of empiric therapy for β-hemolytic streptococcal infection is recommended, based on the patient's clinical response. Clindamycin is an option but CA-MRSA resistance can exceed 50%. For mild cases of pustulosis with localized disease, topical treatment with mupirocin may be adequate in full-term neonates and young infants. Methods An open-label, multicentre, randomised controlled trial (RCT) will compare outcome … A regimen of continuous infusion is not recommended. Gentamicin, sold under brand name Garamycin among others, is an antibiotic used to treat several types of bacterial infections. Simple abscesses or boils may be … For early-onset spinal implant infections (30 days or less after surgery) or implants in an actively infected site, initial parenteral therapy plus rifampin followed by prolonged oral therapy is recommended. In children, intravenous vancomycin is recommended for treating MRSA pneumonia. Clindamycin has been successfully used against staphylococcal bone and joint infections, especially in children, 89, 90 but rarely in adults. Contact It is not effective for gonorrhea or chlamydia infections. For late-onset infections (more than 30 days after surgery), device removal is recommended. Rifampin has excellent in vitro activity against community-acquired MRSA, but it cannot be used by itself because of rapid development of resistance, which can occur during active treatment. If the child is stable without ongoing bacteremia or intravascular infection, empiric therapy with clindamycin (10 to 13 mg per kg intravenously every six to eight hours for a total of 40 mg per kg per day) is an option if the resistance rate is less than 10 percent. There have been reports of resistance to vancomycin through a heteroresistance mechanism, but this is not easily identified with clinical microbiology testing and requires special detection techniques. Lincosamides such as clindamycin bind to the 50S subunit of the bacterial ribosome similarly to macrolides such as erythromycin and inhibit the early stages of protein synthesis. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Options for treating both β-hemolytic streptococci and community-associated MRSA include clindamycin alone, TMP/SMX or a tetracycline in combination with a beta-lactam antibiotic (e.g., amoxicillin), or linezolid alone. A search for and removal of other foci of infection, drainage, or surgical debridement is recommended. It can also be used to treat acne, and some cases of methicillin-resistant Staphylococcus aureus (MRSA). Its major disadvantage is … Although linezolid may prove useful for community-acquired MRSA-associated pneumonia, there are no studies examining this to date. Get Permissions, Access the latest issue of American Family Physician. / Vol. Child dosage for clindamycin: 2 to 8 mg per kg every six to eight hours. For adults with complicated bacteremia (positive blood culture results without meeting criteria for uncomplicated bacteremia), four to six weeks of therapy is recommended, depending on the extent of infection. Sign up for the free AFP email table of contents. Empiric therapy for five to 10 days is recommended pending culture results for outpatients with purulent cellulitis. Add MRSA coverage if purulent or severe disease. MRSA coverage should be considered if the patient has a history of recurrent cutaneous MRSA abscesses, residence in a nursing home with endemic MRSA, or other predisposing condition. Transesophageal echocardiography is preferred over transthoracic echocardiography. Sign up for the free AFP email table of contents. Trimethoprim/sulfamethoxazole (Bactrim, Septra), One to two double-strength tablets (160/800 mg) every 12 hours, 100 mg IV once, then 50 mg IV every 12 hours. Some experts recommend adding oral rifampin (600 mg per day, or 300 to 450 mg twice per day) to the chosen antibiotic. Recommended treatment is intravenous vancomycin for four to six weeks. / afp If the patient has had a previous clinical and microbiologic response to vancomycin, it may be continued with close follow-up. For hospitalized patients with complicated skin and soft-tissue infections (i.e., deeper soft-tissue infections, surgical or traumatic wound infection, major abscesses, cellulitis, or infected ulcers and burns), empiric therapy for MRSA should be considered pending culture results, in addition to surgical debridement and broad-spectrum antibiotics. However, MRSA strains with heteroresistance to vancomycin may exhibit a similar effect with daptomycin. A glycopeptide can be used for pneumonia associated with MRSA; if a glycopeptide is unsuitable, linezolid can be used on expert advice. Alternatives include linezolid and TMP/SMX. They concluded that trimethoprim-sulfamethoxazole and clindamycin were better than cephalexin. This content is owned by the AAFP. If household or interpersonal transmission is suspected, patients and contacts should be instructed to practice personal and environmental hygiene measures. Recommended treatment for adults with uncomplicated bacteremia includes vancomycin or daptomycin at a dosage of 6 mg per kg intravenously once per day for at least two weeks. Setting Emergency department attendances and general practice referrals within 20 hospitals in England. Treatment options for health care–associated MRSA or community-associated MRSA pneumonia include seven to 21 days of intravenous vancomycin or linezolid, or clindamycin (600 mg orally or intravenously three times per day) if the strain is susceptible. Clindamycin The dose of clindamycin used for treating MRSA is 300 to 450 mg every eight hours for adults, and the dose for children is based on weight, according to the Washington State Department of Health 3. The findings of the CDDEP team could help future researchers and medical professionals screen more selectively for resistant bacteria, according to Sumanth Gandra, post-doctoral scholar at CDDEP and lead author on the analysis. Although daptomycin (Cubicin) has not been widely studied for treatment of community-acquired MRSA, it has recently been approved for treating bacteremia and right-sided endocarditis caused by S. aureus (including MRSA). Resistance to clindamycin varies widely, from less than 12 percent in San Francisco, Calif., to as much as 76 percent in Boston, Mass. All rights Reserved. Parenteral therapy is available for serious community-acquired MRSA infections. *— Child dosage for clindamycin: 2 to 8 mg per kg every six to eight hours. This may be sufficient to treat small, uncomplicated purulent lesions, although clear evidence is lacking. http://cid.oxfordjournals.org/content/early/2011/01/04/cid.ciq146.full. Clindamycin 900 mg IV q8h . Clindamycin and linezolid should not be used if there is concern of infective endocarditis or an endovascular source of infection, although they may be considered in children with bacteremia that rapidly clears and is not related to an endovascular focus. If the strain is susceptible, transition to oral therapy is advised. Clindamycin is a lincosamide antibiotic that has been approved by the US Food and Drug Administration for the treatment of anaerobic, streptococcal, and staphylococcal infections. Staphylococcal bone and joint infections such as osteomyelitis, Peritonitis, Intra-abdominal sepsis, Meticillin-resistant Staphylococcus aureus(MRSA) in bronchiectasis, bone and joint infections, and skin and soft-tissue infections. Tigecycline (Tygacil) has been shown to be noninferior to vancomycin for serious MRSA infections, but the number of patients studied to date has been relatively small. If using parenteral abx, empiric choices include coverage for both MRSA and MSSA. Don't miss a single issue. Empiric therapy options include intravenous vancomycin, linezolid (600 mg orally or intravenously twice per day), daptomycin (Cubicin; 4 mg per kg intravenously once per day), telavancin (Vibativ; 10 mg per kg intravenously once per day), or clindamycin (600 mg intravenously or orally three times per day). The duration of therapy should be individualized, but a minimum of three to four weeks is recommended for patients with septic arthritis, and four to six weeks for patients with osteomyelitis. Antibiotics are recommended for patients who have abscesses associated with severe or extensive disease (e.g., multiple sites of infection) or rapid progression in the presence of associated cellulitis; signs and symptoms of systemic illness; associated comorbidities or immunosuppression; very young or very old age; abscesses in areas difficult to drain (e.g., face, hand, genitalia); associated septic phlebitis; or lack of response to incision and drainage alone. In children, intravenous vancomycin (15 mg per kg every six hours) is recommended for treating bacteremia and infective endocarditis. Antibiotic options for parenteral administration include intravenous vancomycin and daptomycin (6 mg per kg intravenously once per day). Double-Disk D-test, to detect this type of inducible resistance ) and linezolid are alternative Treatments for methicillin-resistant... Are relatively minor soft-tissue and skin infections, and some cases of pustulosis with localized disease, topical with. Guidelines: IDSA guidelines on the treatment of limb cellulitis and improve outcomes in severe S. aureus infections parenteral... Abscess is recommended source and extent of the joint space should be performed it is inactivated by surfactant! Widely used in children, intravenous vancomycin for four to six weeks c. septicum ) - Aqueous G... 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