Management of Staphylococcus aureus Infections - December 15, 2005 -- American Family Physician
More than half of all patients who develop S. aureus infections while in the hospital are found to have MRSA (methicillin resistant Staph. aureus). Vancomycin is the drug of choice in the treatment of MRSA. With the development of vancomycin resistant strains, it is important for physicians and patients to be aware of alternatives to vancomycin. Luckily, there are several alternatives available.
A fairly recent review article from American Family Physician (AFP), summarizes these alternatives. Linezolid (Zyvox) can be used for all types of MRSA infections, but is especially useful in treating hospital acquired MRSA pneumonia. One article found that it was actually superior to Vancomycin in this setting. Daptomycin (Cubicin) can be used for all complicated MRSA infections EXCEPT pneumonia.
Patients who develop simple MRSA skin infections outside of the hospital can usually be treated with trimethoprim/sulfamethoxazole (Bactrim), doxycycline, or possibly a fluoroquinolone such as gati- or levofloxicin.
In patients found to have methacillin susceptible S. aureus (MSSA), the treatment should be easier. Oral dicloxacillin or IV nafcillin or oxacillin (known as semi-synthetic penicillins) are preferred. Oral cephalexin (Keflex) or IV cefazolin (Ancef) (known as 1st generation cephalosporins) are a good alternative. In this setting, Vancomycin should be reserved for patients who are allergic to penicillins.
The article goes on to describe aspects of treatment specific to the various body systems that may be infected by S. aureus. ...very good reading.