General Question

Rshapiro's avatar

What antibiotics work for mrsa?

Asked by Rshapiro (4points) May 23rd, 2010

If somone is on keflex for a skin infection and it is not responding what would be a second antibiotic to add

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20 Answers

Dr_Dredd's avatar

Depends. Ideally you could get a wound culture and given whatever the bacteria is susceptible to.

The knee-jerk answer is usually to give vancomycin, which is why we’re now seeing so much resistance to it.

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Lightlyseared's avatar

What makes you think it’s MRSA?

Vancomycin can only be given IV and requires dailly blood work to ensure it doesn’t screw your kidneys too bad.
Linezolid and teicoplanin can also be used to treat some strains of MRSA.

ANef_is_Enuf's avatar

@Lightlyseared is that true? I’ve had patients taking vancomycin oral…. is there a difference between the two despite having the same name?

Dr_C's avatar

The emergence of vancomycin-resistant organisms means that it is increasingly being displaced from this role by linezolid and daptomycin. However unless you know through culture and susceptibility testing what microorganism you are dealing with suggesting a specific antibiotic therapy is premature.

The difference between oral and IV vancomycin resides in the use of the drug and not a chemical difference. It is a large hydrophilic molecule which partitions poorly across the gastrointestinal mucosa. The only indication for oral vancomycin therapy is in the treatment of pseudomembranous colitis, where it must be given orally to reach the site of infection in the colon.

First make sure to have the microorganism identified, it’s susceptibility found and then have your physician figure out the best course of treatment.

ANef_is_Enuf's avatar

@Dr_C thanks, that makes sense.

Rarebear's avatar

Septra/Bactrim and clindamycin are two oral antibiotics that will treat MRSA.

Lightlyseared's avatar

@Rarebear So clindamycin for the skin infection, then vancomycin to treat the C Diff. Can you bill twice for that?

Rarebear's avatar

@Lightlyseared The incidence of c.diff is actually relatively low with clindamycin—just higher than baseline. I’ve used Clinda lots, especially in the sulfa allergic.

Lightlyseared's avatar

So you can’t bill the patients twice then?

Rarebear's avatar

@Lightlyseared Personally, I don’t even bill the patients once. I’m a salaried employee. You’d have to ask someone in private practice about billing issues.

Dr_C's avatar

@Lightlyseared unless the condition calls for empirical treatment based on urgency I will usually do everything possible to identify the infecting agent and provide the appropriate treatment.

No double billing for me.

shilolo's avatar

In order of choice (also, in reverse order of severity of illness):
1. Trimethoprim/sulfamethoxazole (Septra/Bactrim) PLUS rifampin (I rarely give septra alone).
2. Doxycycline ± rifampin
3. Clindamycin (though I use this less than the two above because there are many strains that have an inducible resistance to clindamycin).
4. Linezolid (cannot be given for any significant length of time owing to side effects).

Intravenous (all ± rifampin)
1. Vancomycin (used to be first choice, now being replaced by…)
2. Daptomycin (probably the best IV MRSA drug out right now)
3. Linezold
4. Tigecycline
5. Rare (desperate) cases: Amoxicillin-clavulonate at high doses

Rarebear's avatar

@shilolo Yes! Forgot we have an infectious disease specialist here.

Dr_Dredd's avatar

And, it’s @shilolo with the win!

Lightlyseared's avatar

@Rarebear & @Dr_C I was not sugesting that you guys would do anything so devious. The original quip was an attempt to be humourous hampered slightly by the fact it was 3am and I was still at work (waiting for an empty theatre)

Dr_C's avatar

and of course @shilolo had to come and spoil everyone’s fun with “facts” and “knowledge”.
such a party pooper. Serioulsy though GA

shilolo's avatar

@Rarebear @Dr_Dredd @Dr_C Nah, I just slept at a holiday inn express last night…

Dr_Dredd's avatar

@shilolo I’m sorry. Why on earth did you do that? :-)

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