Mrsa mrse coag negative staph epi enterococcus usage

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MRSA, MRSE, (coag negative staph epi), enterococcus Usage should be limited to infections not susceptible to other agents Empirical dosing: 15-20 mg/kg q8-12h for MRSA infections 1 g IV q12h for ABSSSIs 80-90% renally cleared Adjust in kidney disease Oral vanc is not absorbed and only effective for C. diff AE Ototoxicity - associated with high peaks (80-90) Nephrotoxicity - as single agent increased nephrotoxicity with higher troughs Occurs when combined with other known nephrotoxic agents Red Man syndrome Presents as maculopapular rash Slow down infusion +/- antihistamines Linezolid (Zyvox) Bacteriostatic agent with activity against MRSA and VRE Weak MAO-i activity Serotonin Syndrome with SSRIs have been reported ABSSSI dose: 400-600 mg IV/PO BID Monitor: CBC, especially platelets Bone marrow suppression can occur anytime but especially two weeks into therapy AE: optic neuritis, lactic acidosis, peripheral neuropathy Which drug can cause Red Man syndrome Vance
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Good activity vs strep and staph Alternative to Vanc for tx of MRSA SSTIs Available orally and IV at 600 mg IV/PO BID MOA: decreases protein synthesis through 50S ribosomal inhibition Nearly 100% BA Toxicities Bone marrow suppression with thrombocytopenia most common Optic neuropathy and lactic acidosis (rare) with long-term therapy Irreversible peripheral neuropathy Drug-Food Interactions W/ adrenergic agents Monitor BP SSRIs Food/ beverages with high tyramine content Can cause HTN Daptomycin (cubicin) Gram-positive coverage Irreversibly binds to bacterial cell membrane, causing rapid depolarization and cell death Bactericidal Dose: 4 mg/kg or 6 mg/kg for SSTIs Must monitor CPKs and muscle symptoms weakly Adjust dosing for renal dysfunction Tedizolid (sivextro) Prodrug converted to active drug Activity against gram-positive including MRSA and VRE Dose: 600 mg IV/PO QD Approved for SSTIs for 6 day course Non-inferior to linezolid (10-day course) Adverse Effects primary AE: GI and CNS Less thrombocytopenia than linezolid but not significant Drug Interactions Weak MAO-A/B inhibitor Less than linezolid No significant “in-vitro” interactions with serotonergic agents Oritavancin (Orbactiv) Lipoglycopeptide derivative of vanc Active against many gram-positive including MRSA Half life = 393 hours Dose: 1200 mg IV once weekly For complicated skin infections 3 hour infusion Possible prevention of admission Drug Interactions
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Increases Warfarin concentrations Interferes with PT/INR and aPTT Adverse Effects Well tolerated (infusion-related interactions) Questions Not recommended for osteomyelitis? Who is appropriate candidate? Dalbavancin (Dalvance) FDA approved for ABSSSI caused by gram-positive organisms One dose regimen: 1500 mg IV over 30 min Two dose regimen:
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  • Fall '19
  • Tetracycline, UTI, Ceftriaxone

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