Monday, January 31, 2011

New MRSA guidelines

The first ever from IDSA. Here's the free full text guideline.

The guideline nails down some of the specifics on questions we might equivocate on or defer to our ID consultants, such as when and how to use adjunctive antibiotics, vancomycin versus daptomycin versus linezolid versus telavancin, and when and how to decolonize.

Of special note, the recommendation for MRSA pneumonia states:

For hospitalized patients with severe community-acquired pneumonia defined by any one of the following: (1) a requirement for intensive care unit (ICU) admission, (2) necrotizing or cavitary infiltrates, or (3) empyema, empirical therapy for MRSA is recommended pending sputum and/or blood culture results (A-III).

That makes perfect sense, but calls for a change in the CAP guidelines which, for patients admitted to ICU, recommend double coverage e.g. with a third generation cephalosporin and a respiratory fluoroquinolone. With the new MRSA guidelines incorporated, a respiratory MRSA drug such as vancomycin will be added to the mix. (Would this result in triple therapy or would it supplant the beta lactam?).

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