Selecting a Treatment Regimen
Table 1. Recommendations for the Treatment of MRSA (cont'd) Manifestation
Treatments
Management/ Surgery
Bone and Joint Infections (continued) VancomycinठSeptic arthritis
Drainage or debridement of the joint space should always be performed (A-II).
Daptomycin‡ (Cubicin®
Treat for 3-4 weeks.
Linezolid (Zyvox®
)
Clindamycin (Cleocin®
others) Device-related Osteoarticular Infections
Early-onset (< 2 months aſter surgery) or acute hematogenous prosthetic joint infections involving a stable implant with short duration (≤ 3 weeks of symptoms), debridement but device retention
Late-onset prosthetic joint infections, unstable implants or long duration (> 3 weeks) of symptoms
Early-onset spinal implant infections (≤ 30 days aſter surgery), or implants in an actively infected site
Late-onset spinal implant infections (> 30 days aſter surgery)
10
Parenteral therapy plus rifampin 600 mg daily or 300-450 mg twice daily for 2 weeks followed by rifampin plus a fluoroquinolone, TMP-SMX, a tetracycline or clindamycin for 3 months (hips) or 6 months (knees).
Antibiotic therapy in conjunction with prompt debridement with device removal.
Parenteral therapy plus rifampin followed by prolonged oral therapy is recommended. The optimal duration of parenteral and oral therapy is unclear; the latter should be continued until spine fusion has occurred. For late-onset infections (> 30 days aſter implant placement), device removal whenever feasible is recommended.
Antibiotic therapy in conjunction with device removal whenever feasible is recommended.
‡ Adjust dose for renal impairment – see Prescribing Information for renal dosing. § Max: 2 gm/dose. In seriously ill patients consider a loading dose of 25-30 mg/kg (C-III).
,
TMP-SMX‡ (Bactrim®
15-20 mg/kg/dose IV q8-12h
) 6 mg/kg/day IV daily
600 mg PO/IV bid
600 mg PO/IV tid
) 3.5-4 mg/kg/dose PO/IV bid
Duration of Therapy
Antibiotics
Agent (Brand)
Adult Dose
