さまよう薬剤師のブログ

学位を持っても、センスのない、感染制御専門薬剤師のブログ.  I have Ph.D. but less sense ID pharmacist.

成人のMRSA感染症の治療

血液培養からGPCがでると
ぞっとします…

しかし、その後の基本プラクティスがいけてないと…さらにぞっとします。

薬剤師は傍観者にならず積極的に参加しないといけない時代。

再び、UpToDate より引用し復習

treatment of invasive methicillin-resistant S. aureus (MRSA) infections in adults

We suggest initial antibiotic management of methicillin-resistant Staphylococcus aureus (MRSA) bacteremia with intravenous vancomycin or daptomycin (Grade 2C). 

Persistent bacteremia may be due to a collection, the presence of a prosthetic device, or an endovascular source of infection that requires surgery. However, if antibiotic failure seems the most likely explanation and if the minimum inhibitory concentration (MIC) approaches the limit of the susceptible range (ie, 2 mcg/mL), vancomycin should be discontinued and therapy switched to an alternative agent. 

If an alternative agent for treatment of MRSA bacteremia is needed due to vancomycin intolerance or inadequate response to treatment, we suggest treating with daptomycin or linezolid (Grade 2C). Susceptibility testing should be performed; in general, we favor daptomycin over linezolid. 

We recommend initial antibiotic management of MRSA osteomyelitis with intravenous vancomycin or daptomycin (Grade 1C).

ちなみに…
Vancomycin kills staphylococci more slowly than do beta-lactam antibiotics in vitro and is clearly inferior to beta-lactams for treatment of methicillin-susceptible S. aureus (MSSA) bacteremia and infective endocarditis.
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