Prospective clinical data are lacking. Specifically, pneumonia patients with negative MRSA nasal swabs are 95-99% likely to not have pneumonia due to MRSA. If concern for MRSA, use vancomycin instead of clindamycin and add anaerobic coverage with metronidazole. Student Voices. Targeting troughs as a surrogate marker for achieving an AUC-to-minimum inhibitory concentration (AUC/MIC) ratio of ≥ 400 is no longer recommended. Cephalexin and cefazolin provide coverage for group A Streptococcus and MSSA. Empiric treatment for P. aeruginosa: 1) Piperacillin-tazobactam 4.5 g q6h 2) Cefepime 2 g q8h 3) Ceftazidime 2 g q8h 4) Aztreonam 2 g q8h 5) Meropenem 1 g q8h o Reassess at 48 hours. If concern for MRSA, add vancomycin-Severe PCN allergy: Ciprofloxacin + Clindamycin OR Aztreonam + Clindamycin. MRSA indicates methicillin-resistant Staphylococcus aureus; VA, Veterans Affairs.. a Standard antibiotics were defined as either a β-lactam plus macrolide or tetracycline, or a respiratory fluoroquinolone (moxifloxacin or levofloxacin). •Anaerobic coverage ... Empiric treatment for MRSA: 1) Vancomycin 15 mg/kg q12h 2) Linezolid 600 mg q12h Ceftaroline? In severely ill, or risk for MRSA, empiric coverage traditionally with vancomycin IV, although daptomycin, ceftaroline or linezolid among others would potentially service depending on the clinical presentation. Orbital cellulitis is a potentially sight- and life-threatening disease that tops the ophthalmology worry list. If lack of improvement or clinical worsening on >48 hours of initial antibiotic therapy, consider adding Coverage for gram negative organisms is not needed except in very specific patient populations (outlined below). β-Lactams included nonpseudomonals (ampicillin, amoxicillin, ampicillin-sulbactam, amoxicillin-clavulanate, cefuroxime, cefotaxime, ceftriaxone, … Studies have reported that a MRSA nasal swab may be used to predict the presence of MRSA pneumonia. Vancomycin IV* (consider if history of MRSA, post-influenza, necrotizing pneumonia) +/- Tobramycin 7 mg/kg IV EIAD (consider if history of Pseudomonas) Nosocomial Pneumonia Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) Treat … Download PDF . Oral Regimens Doxycycline 100 mg PO BID PLUS Cephalexin 500 mg PO QID OR Amoxicillin 500 mg PO TID OR TMP/SMX 1-2 DS tab PO BID The following regimens include coverage for MSSA, community-acquired MRSA (CA-MRSA), and streptococci. Alternative if need for MRSA coverage1: Vancomycin IV* Duration: 5 days May extend therapy up to 7-10 days if lack of symptom resolution at 5 days. i.e. MRSA pneumonia – 15-20mg/L) Urinalysis, BUN, SCr, skin rash, Neutropenia Brand names/Manufacturer: Vancomycin (Various generic manufacturers worldwide) Biovancomin - Biosintetica, Brazil Copovan - Biologici Italia Diatracin - Dista, Spain Edicin – Lek, Hungary Thailand, and Czech Republic Estavam - Precimex, Mexico Farmaciclin Uno, Italy MRSA colonization or infection, intravenous drug use, a recent stay in a nursing home or skilled nursing facility, prolonged hospitalization with unknown MRSA colonization status, or other risk factors for MRSA o It is not necessary to add additional anaerobic or atypical coverage. ... 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