TAILIEUCHUNG - Chapter 129. Staphylococcal Infections (Part 11)

Table 129-3 Antimicrobial Therapy for Serious Staphylococcal Infectionsa Sensitivity/Resis tance of Isolate Drug of Choice s) Alternative( Comments Sensitive penicillin to Penicilli Nafcillin (2 Fewer than n G (4 mU q4h) g q4h) or oxacillin 5% of isolates are (2 g q4h), cefazolin sensitive (2 g q8h), penicillin. to vancomycin (1 g q12hb) Sensitive to Nafcillin Cefazolin (2 Patients with methicillin or oxacillin (2 g g q4h) q8hb), penicillin allergy vancomycin (1 g can be treated with q12hb) a cephalosporin if the allergy does not involve anaphylactic accelerated reaction; vancomycin is the alternative. Desensitization to an or β-lactams may be indicated in selected cases of serious where infection maximal bactericidal activity is needed (., prosthetic-valve endocarditisc). Type A β-lactamase may rapidly cefazolin hydrolyze and reduce its efficacy in. | Chapter 129. Staphylococcal Infections Part 11 Table 129-3 Antimicrobial Therapy for Serious Staphylococcal Infections Sensitivity Resis tance of Isolate Drug of Choice Alternative s Comments Sensitive to penicillin Penicilli n G 4 mU q4h Nafcillin 2 g q4h or oxacillin 2 g q4h cefazolin 2 g q8h vancomycin 1 g q12hố Fewer than 5 of isolates are sensitive to penicillin. Sensitive to Nafcillin Cefazolin 2 Patients with methicillin or oxacillin 2 g q4h g q8hố vancomycin 1 g q12hố penicillin allergy can be treated with a cephalosporin if the allergy does not involve an anaphylactic or accelerated reaction vancomycin is the alternative. Desensitization to 0-lactams may be indicated in selected cases of serious infection where maximal bactericidal activity is needed . prosthetic-valve endocarditisc . Type A 0-lactamase may rapidly hydrolyze cefazolin and reduce its efficacy in endocarditis. Resistant to methicillin Vancom ycin 1 g q12hố TMP-SMX TMP 5 mg kg q12h minocycline or doxycycline 100 mg PO q12hố ciprofloxacin 400 mg q12hố levofloxacin 500 mg q24hố quinupristin dalfopr istin mg kg q8h linezolid 600 mg q12h except 400 mg q12h for Sensitivity testing is necessary before an alternative drug is used. Adjunctive drugs those that should be used only in combination with other antimicrobial agents include gentamicin 1 mg kg q8hố rifampin 300 mg PO q8h and fusidic acid .

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