| Infectious Disease Update |
| Infectious Disease Updates by Sarmistha B. Hauger, M.D., Specialist in Pediatric Infectious Disease |
| Empiric Therapy for Suspected CA-MRSA Skin Infections Adults Primary Trimethoprim/sulfamethoxazole (TMP/SMX) - Bactrim®* 1 Double Strength tablet PO every 12 hours * Contraindicated in pregnancy † Based on normal renal function OR Minocycline (Minocin®) or Doxycycline (Vibramycin®)* Minocycline 100 mg PO every 12 hours Doxycyline 100 mg PO every 12 hours * Contraindicated in pregnancy Alternative* Clindamycin (Cleocin®)†‡ 300 mg PO QID * Patient has contraindications to TMP/SMX and Tetracyclines † Follow culture and sensitivity report. If MRSA is clindamycin resistant and continued antimicrobial therapy is indicated, change to an appropriate antibiotic. If MRSA is sensitive to clindamycin, but resistant to erythromycin, clindamycin may not be effective. If continued antimicrobial therapy is indicated, a D- Test may be ordered on the MRSA isolate. If inducible resistance to clindamycin is demonstrated (positive D- Test), and continued antimicrobial therapy is still indicated, change to an appropriate antibiotic. ‡ Clindamycin (pregnancy category B) may be used during pregnancy if necessary. If the MRSA isolate is resistant to clindamycin, an Infectious Disease consult is recommended. The use of fluoroquinolones for the treatment of CA-MRSA infections is not recommended due to the potential for the development of resistance during therapy. Empiric Therapy for Suspected CA-MRSA Skin Infections Children Primary Trimethoprim/sulfamethoxazole (TMP/SMX) - Bactrim® TMP/SMX Oral Suspension = TMP 40mg / SMX 200 mg per 5 ml 1 Single Strength tablet = 80 mg TMP/ 400 mg SMX Children less than 30 kg* and greater than or equal to one month of age: 5 mg TMP component /kg/dose PO every 12 hours * If greater than or equal to 30 kg, use adult dosing chart OR Clindamycin (Cleocin®)† Oral Solution: 75 mg/ 5 ml Capsules: 75 mg, 150 mg, 300 mg Children less than 30 kg‡: 10 mg/kg/dose (up to 300 mg/dose) PO QID Alternative* For Children above the age of 8 Doxycycline (Vibramycin®) Oral Suspension: 25 mg/ 5 ml Oral Syrup: 50 mg/5 ml Tablets or Capsules: 50 mg, 100 mg 2 mg/kg/dose (up to 100 mg/dose) PO every 12 hours * Patient has contraindications to TMP/SMX and Tetracyclines † Follow culture and sensitivity report. If MRSA is clindamycin resistant and continued antimicrobial therapy is indicated, change to an appropriate antibiotic. If MRSA is sensitive to clindamycin, but resistant to erythromycin, clindamycin may not be effective. If continued antimicrobial therapy is indicated, a D- Test may be ordered on the MRSA isolate. If inducible resistance to clindamycin is demonstrated (positive D- Test), and continued antimicrobial therapy is still indicated, change to an appropriate antibiotic. ‡ If greater than or equal to 30 kg, use adult dosing chart. The use of fluoroquinolones for the treatment of CA-MRSA infections is not recommended due to the potential for the development of resistance during therapy. |
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