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Understanding Pharm: Antibiotics for difficult organisms – Staphylococcus aureus, VRE, anaerobic and Pseudomonas

MSSA

  • Cloxacillin is first line
  • Cephalexin/cefazolin
  • Clindamycin (fading coverage for MSSA)

MRSA

  • Vancomycin is first line (especially for hospital associated MRSA)
  • Other options
    • Linezolid
    • Daptomycin
    • Tigecycline
    • Ceftaroline (5th generation cephalosporin)
  • Oral options for outpatient management can be used for community associated MRSA
    • Options
      • TMP-SMX (septra) but also available in IV
      • Doxycycline
    • Risk factors
      • Prison, indigenous, MSM, contact sports

VRE

  • Linezolid
  • Daptomycin
  • Tigecycline

Pseudomonas

  • Piperacillin/tazobactam (Piptazo)
    • Also has anaerobic coverage
  • Ceftazidime (3rd generation cephalosporin)
  • Cefepime (4th generation cephalosporin)
  • Ceftobiprole (5th generation cephalosporin)
  • Carbapenems (except ertapenem)
    • Meropenem
    • Imipenem
  • Aminoglycosides
    • Gentamicin, Amikacin, tobramycin, neomycin, streptomycin
  • PO option
    • Ciprofloxacin

Anaerobic coverage

  • Penicillin + beta-lactamase inhibitor
    • Piperacillin/tazobactam (Piptazo)
    • Amoxicillin/clavulanate
    • Ampicillin/sulbactam
  • Carbapenems
    • Meropenem
    • Imipenem
    • Ertapenem
  • Clindamycin
  • Metronidazole
  • Moxifloxacin (fluoroquinolones)
  • Tigecycline