Guidelines for Superbugs

This short and sweet table was posted on the Irish Medical Times this morning (No Fooling on April Fools)! Enjoy

MRSA Guidelines

The wide spectrum of illness caused by MRSA includes skin and soft tissue infections, bacteremia and endocarditis, pneumonia, bone and joint infections, UTI and CNS disease.

Table: Guidelines for the treatment of MRSA1,2 
– Step-down therapy from agent encompassing MRSA to flucloxacillin, unless known very low MRSA rates.
– As a general rule, use glycopeptides for severe MRSA infection
Skin and soft tissue infections (SSTIs )

  • Cellulitis and surgical site infections:

      Severe or where the risk of bacteraemia is high: Glycopeptides, linezolid, daptomycin, clindamycin.2

      Not severe, low risk, in non-hospitalised patients: Doxycycline, clindamycin, trimethoprim-sulfamethoxazole (TMP-SMX)2

  • Polymicrobial (e.g. diabetic foot infections): Monotherapy with tigecycline.1
  • Impetigo: Topical mupirocin or fusidic acid, where the isolate is susceptible.1
Severe intravenous site infections

  • Associated with severe induration, cellulitis or bacteraemia*: IV glycopeptide, daptomycin for 4–6 weeks (complicated bacteraemia).2
  • Uncomplicated bacteraemia: Glycopeptides, daptomycin for at least 14 days.2
Urinary tract infections

  • Simple: Oral agent (nitrofurantoin, trimethoprim, co-trimoxazole or tetracycline).1
  • Complicated: Glycopeptides or daptomycin.1
Bone and joint infectionsParenteral glycopeptides such as vancomycin with/without rifampicin or sodium fusidate.1Also daptomycin, TMP-SMX with rifampicin, linezolid, clindamycin.2
Respiratory infections
Without pneumonia: Unresolved. MRSA pneumonia: Glycopeptide, linezolid, clindamycin if susceptible for 7–21 days.2
CNS infections
Vancomycin for 4–6 weeks with/without rifampicin, linezolid  and TMPSMX.2

* including infective endocarditis (treatment duration 6 weeks recommended)


References: 1- Gould FK, Brindle R, Chadwick PR, et al. Guidelines (2008) for the prophylaxis and treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections in the United Kingdom. J Antimicrob Chemother. 2009 Mar 12.

2- Liu C, Arnold Bayer A, Cosgrove SE, et al. (2011) Clinical Practice Guidelines by the Infectious Diseases Society of America for the Treatment of Methicillin-Resistant Staphylococcus Aureus Infections in Adults and Children (IDSA), 2011 CID 2011:52. 


Discharge Planning and HCAI

Many patients with healthcare associated infections (HCAI) can be discharged. It is recommended to encourage early discharge with oral treatment or out-patient based parenteral treatment to avoid further risk of acquiring a HCAI and reduce the financial burden of MRSA management.

Advantages of appropriate discharge with home antibiotic treatment
Patient Benefits Hospital Benefits
 Convalescence in comfort of homeAvoiding the discomfort and risk of infection associated with an intravenous line, when switched to oral antibiotics Reduced risk of acquiring HCAI   Potential reduction in rates of HCAIImproved bed management enabling more patients to be admitted and treatedReduced duration of hospital stay, with associated cost savings  


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