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2010年10月13日 星期三

How to Treat MRSA?

[Current Medications]
IV. Vancomycin, Teicoplanin, Tigecycline, linezolid, Daptomycin.
(if endocarditis, 1st seldom use linezoid, Daptomycin documented only 2 indication: Bacteremia, Endocarditis.)
Po. Rifampin, Doxycycline/ Clindamycin, Baktar, chloramphenicol, Fusidic Acid.

Something should know:
Situation1:
Allergic to Vancomycin for treating MRSA.
1.    could use Teicoplanin first. (if Bacteremia, should not use Tigecycline, for its good protein and tissue combine ability and thus low concentration in blood)

Situation2:
If Vancomycin failure for MRSA:
1.    should not use Teicoplanin, because MRSA resistant to Vanco usually also to Teico.
2.    If also accompany pneumonia, should not use Daptomycin, for its poor function in lung due to surfactant.
3.    Other I.V Abx could choose according to clinical condition.

Situation3:
The one could not use for MRSA as monotherapy: Fusidic Acid.

Situation4:
If pt had carbuncle and w/c yield: MRSA, when to use Abx:
1.    if pt had other persistant systemic infection sign, like fever.
2.    If the local inflammation area still > 2cm diameter
3.    And if use Abx, only Vanco, let alone Oxacillin.

Situation5:
If B/C showed MSSA, then which Abx to choose?
1.    oxacillin 3 days, → B/C (-)
2.    Vanco 7days, → B/C (-)
3.    Vanco + Rifampin 9days, → B/C (-)
p.s. due to high rate >50% community MRSA in USA, they now use full dose combined giving Vanco and Oxacillin for both benefit. Perspective RCT was still going.

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