Chapter 129. Staphylococcal Infections (Part 11)

Chia sẻ: Colgate Colgate | Ngày: | Loại File: PDF | Số trang:8

Thêm vào BST

Báo xấu

67
lượt xem 3
download

Download Vui lòng tải xuống để xem tài liệu đầy đủ

Table 129-3 Antimicrobial Therapy for Serious Staphylococcal Infectionsa Sensitivity/Resis tance of Isolate Drug of Choice s) Alternative( Comments Sensitive penicillin to Penicilli Nafcillin (2 Fewer than n G (4 mU q4h) g q4h) or oxacillin 5% of isolates are (2 g q4h), cefazolin sensitive (2 g q8h), penicillin. to vancomycin (1 g q12hb) Sensitive to Nafcillin Cefazolin (2 Patients with methicillin or oxacillin (2 g g q4h) q8hb), penicillin allergy vancomycin (1 g can be treated with q12hb) a cephalosporin if the allergy does not involve anaphylactic accelerated reaction; vancomycin is the alternative. Desensitization to an or β-lactams may be indicated in selected cases of serious where infection maximal bactericidal activity is needed (e.g., prosthetic-valve endocarditisc). Type A β-lactamase may rapidly cefazolin hydrolyze and reduce its efficacy in...

Chủ đề:

Bình luận(0) Đăng nhập để gửi bình luận!

Lưu

Nội dung Text: Chapter 129. Staphylococcal Infections (Part 11)

Chapter 129. Staphylococcal Infections (Part 11) Table 129-3 Antimicrobial Therapy for Serious Staphylococcal Infectionsa Sensitivity/Resis Drug of Alternative( Comments tance of Isolate Choice s) Sensitive to Penicilli Nafcillin (2 Fewer than penicillin n G (4 mU q4h) g q4h) or oxacillin 5% of isolates are (2 g q4h), cefazolin sensitive to (2 g q8h), penicillin. vancomycin (1 g q12hb) Sensitive to Nafcillin Cefazolin (2 Patients with
methicillin or oxacillin (2 g g q8hb), penicillin allergy q4h) vancomycin (1 g can be treated with q12hb) a cephalosporin if the allergy does not involve an anaphylactic or accelerated reaction; vancomycin is the alternative. Desensitization to β-lactams may be indicated in selected cases of serious infection where maximal bactericidal activity is needed (e.g., prosthetic-valve endocarditisc). Type A β-lactamase may
rapidly hydrolyze cefazolin and reduce its efficacy in endocarditis. Resistant to Vancom TMP-SMX Sensitivity methicillin ycin (1 g q12hb) (TMP, 5 mg/kg testing is necessary q12hb), before an alternative minocycline or drug is used. doxycycline(100 Adjunctive drugs mg PO q12hb), (those that should ciprofloxacin (400 be used only in mg q12hb), combination with levofloxacin (500 other antimicrobial mg q24hb), agents) include quinupristin/dalfopr gentamicin (1 istin (7.5 mg/kg mg/kg q8hb), q8h), linezolid (600 rifampin (300 mg mg q12h except: PO q8h), and 400 mg q12h for fusidic acid (500
uncomplicated skin mg q8h; not readily infections); available in the daptomycin (4–6 United States). mg/kg q24hb, c) for Quinupristin/dalfopr bacteremia, istin is bactericidal endocarditis, and against methicillin- complicated skin resistant isolates infections; unless the strain is tigecycline (100 mg resistant to IV once, then 50 erythromycin or mg q12h) for skin clindamycin. The and soft tissue newer quinolones infections; may retain in vitro investigational activity against drugs: oritavancin, ciprofloxacin- dalbavancin, resistant isolates; telavancin resistance may develop during therapy. The efficacy of adjunctive therapy
is not well established in many settings. Both linezolid and quinupristin/dalfopr istin have had in vitro activity against most VISA and VRSA strains. See footnote for treatment of prosthetic-valve endocarditis.d Resistant to Uncertai Same as for Same as for methicillin with n methicillin-resistant methicillin-resistant intermediate or strains; check strains; check complete resistance to antibiotic antibiotic vancomycine susceptibilities susceptibilities.
Not yet known Vancom — Empirical (i.e., empirical therapy) ycin (1 g q12h) therapy is given when the susceptibility of the isolate is not known. Vancomycin with or without an aminoglycoside is recommended for suspected community- or hospital-acquired S. aureus infections because of the increased frequency of methicillin- resistant strains in the community.
a Recommendeddosages are for adults with normal renal and hepatic function. Theroute of administration is intravenous unless otherwise indicated. b The dosage must be adjusted inpatients with reduced creatinine clearance. c Daptomycin cannot be used forpneumonia. d For the treatment of prosthetic-valveendocarditis, the addition of gentamicin (1 mg/kg q8h)and rifampin (300 mg PO q8h) is recommended, with adjustment of thegentamicin dosage if the creatinine clearance rate is reduced. e Vancomycin-resistant S. aureus isolates from clinical infectionshave been reported. Source: Modified withpermission of the New England Journal ofMedicine (Lowy, 1998). © 1998 Massachusetts MedicalSociety. All rights reserved. Note:TMP-SMX, trimethoprim-sulfamethoxazole;VISA, vancomycin- intermediate S. aureus;VRSA, vancomycin-resistant S. aureus.