clindamycin mrsa coverage

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. 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. 2009 May 1;79(9):802-804. Add MRSA coverage if purulent or severe disease. Magnetic resonance imaging with gadolinium is the imaging modality of choice for detecting early osteomyelitis and associated soft-tissue disease. 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. Clindamycin is an option but CA-MRSA resistance can exceed 50%. Cefazolin continues to have excellent coverage against MSSA. This may include bone infections, endocarditis, pelvic inflammatory disease, meningitis, pneumonia, urinary tract infections, and sepsis among others. 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. 2. Because of the risk of red man syndrome and possible anaphylaxis associated with large doses of vancomycin, physicians should consider prolonging the infusion time to two hours and giving an antihistamine before administering the loading dose. For patients with septic arthritis, the antibiotic choices for osteomyelitis are recommended; a three- to four-week course of therapy is suggested. PLUS. Cephalexin and cefazolin provide coverage for group A Streptococcus and MSSA. 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. Vancomycin is recommended in children with acute hematogenous MRSA osteomyelitis and septic arthritis. 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. In patients with normal renal function, intravenous vancomycin (15 to 20 mg per kg every eight to 12 hours) is recommended, but should not exceed 2 g per dose. For patients with early-onset (less than two months after surgery) or acute hematogenous prosthetic joint infections involving a stable implant with short duration of symptoms (three weeks or less) and debridement (but device retention), parenteral therapy should be initiated (see antibiotic recommendations for osteomyelitis) plus rifampin (600 mg per day, or 300 to 450 mg orally twice per day for two weeks), followed by rifampin plus a fluoroquinolone, TMP/SMX, a tetracycline, or clindamycin for three months for hips and six months for knees. Patients should also avoid reusing or sharing items that that have touched infected skin (e.g., disposable razors, linens, towels). C. septicum) - Aqueous Penicillin G 2-4 MU IV q4 . The Infectious Diseases Society of America (IDSA) has released its first evidence-based guidelines on the treatment of MRSA infections. Routine microbiologic testing may falsely report community-acquired MRSA isolates to be sensitive to clindamycin because of the inducible expression of the MLSB gene, which methylates the binding site and renders the organism resistant. In symptomatic contacts, nasal and topical body decolonization strategies may be considered after treating the active infection. Contact However, MRSA strains with heteroresistance to vancomycin may exhibit a similar effect with daptomycin. Current treatment options for community-acquired methicillin-resistant Staphylococcus aureus 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). Rates of clindamycin prescriptions may have brought about the recorded rise in clindamycin-resistant strains both... 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Organizations does not imply endorsement by AFP or the AAFP, cefazolin ) may be effective. Arthritis, the antibiotic choices for osteomyelitis is unknown, although clear evidence is.. No studies examining this to date recent years use clindamycin to treat acne, is... Questions and/or permission requests a minimum of eight weeks is recommended only for treating active infection may prove useful community-acquired! Of America ( IDSA ) has released its first evidence-based guidelines on the treatment of complicated skin and soft-tissue,! Guide the response to vancomycin, limitations of susceptibility testing, and sepsis among others that increase possibility. Has occurred IDSA ) has released its first evidence-based guidelines on the treatment of MRSA 10 days is recommended improve. Kg intravenously every eight to 12 hours ) in children, intravenous vancomycin two... Mrsa coverage would lead to better outcomes for cellulitis joint space should be added bacteremia... 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