In the category of FWIW, I found this protocol on the net for treatment of MRSA:
healthplanofnevada.com
MRSA infections may be further broken down into four groups:
A. Superficial colonization of a wound, without signs of infection
B. Superficial soft tissue infection/cellulitis
C. Complex skin and skin structure infection
D. Osteomyelitis
A. Superficial colonization of a wound, without signs of infection (Hospital or Community Acquired)
• May be treated without the use of oral or IV antibiotics.
• Regular cleansing of the wound with Hibiclense
• Topical application of a silver dressing with activity against MRSA such as Acticoat or Silvasorb
• Close monitoring of the wound for possible signs of infection
Notes:
Hibiclens - manufactured by privately held Mölnlycke Health Care of Sweden
Silvasorb - manufactured by privately held MedLine
Acticoat - manufactured by Smith & Nephew NYSE:SNN
B. Superficial skin and soft tissue infection/cellulitis (Hospital or Community Acquired)
• Local wound cleansing and debridement must be accompanied by antibiotic therapy.
• Should be treated with antibiotics for at least ten days but may vary depending on severity of infection and clinical response. Antibiotic choice should include one of the following:
--- Trimethoprim-sulfamethoxazole-1 tablet PO bid
--- Minocycline or Doxycycline-100 mg PO bid
--- Rifampin (Adult dose: 300 mg PO bid x 5 days; pediatric dose: 10-20 mg/kg/day in 2 doses not to exceed 600 mg/d x 5 days) in combination with Trimethoprim-sulfamethoxazole, Minocycline, or Doxycycline has been shown to have a synergistic activity against MRSA. Never use Rifampin as monotherapy due to rapid emergence of resistance.
• If a failure of treatment with any of the above antibiotics has occurred, consider use of Zyvox* 600 mg. Q12 h PO.
--- Any use of Zyvox* for greater than 10 days requires close monitoring for Myelosuppression (including anemia, leukopenia, pancytopenia, and thrombocytopenia)
C. Complex skin and skin structure infection may be treated as follows:
1. Community Acquired:
• Aggressive debridement of necrotic and infected skin and deep soft tissue structures is essential to the success of any antibiotic therapy.
• Peripheral vascular sufficiency should be established immediately and a vascular consult ordered if there are questions as to peripheral vascular disease.
• Should be treated with antibiotics for at least ten days but may vary depending on severity of infection and clinical response. Antibiotic choice should include one of the following:
--- Trimethoprim-sulfamethoxazole-1 tablet PO bid
--- Minocycline or Doxycycline-100 mg PO bid
--- Rifampin (Adult dose: 300 mg PO bid x 5 days; pediatric dose: 10-20 mg/kg/day in 2 doses not to exceed 600 mg/d x 5 days) in combination with Trimethoprim-sulfamethoxazole, Minocycline, or Doxycycline has been shown to have a synergistic activity against MRSA. Never use Rifampin as monotherapy due to rapid emergence of resistance.
• If a failure of treatment with any of the above antibiotics has occurred, consider use of Zyvox* 600 mg. Q12 h PO.
- Any use of Zyvox* for greater than 10 days requires close monitoring for Myelosuppression (including anemia, leukopenia, pancytopenia, and thrombocytopenia)
2. Hospital Acquired:
• Aggressive debridement of necrotic and infected skin and deep soft tissue structures is essential to the success of any antibiotic therapy.
• Peripheral vascular sufficiency should be established immediately and a vascular consult ordered if there are questions as to peripheral vascular disease.
• Once MRSA has been positively identified, the patient may be placed on a two to three week course of Zyvox* 600 mg. Q12 h PO.
• Any use of Zyvox* for greater than 10 days requires close monitoring for Mylosuppression (including enema, leukopenia, pancytopenia, and thrombocytopenia)
• If it is felt that the infection will require greater than three weeks of antibiotic therapy, the patient should be immediately placed on Vancomycin IV with weekly monitoring of peaks and troughs with BUN and Creatinine.
• Vancomycin is only delivered by IV and a PICC will need to be ordered for long term therapy
• Vancomycin should be adjusted to therapeutic levels and to avoid toxic response such as nephrotoxicity, ototoxicity, and thrombocytopenia
• Zyvox* may be used in lieu of Vancomycin in the case of renal insufficiency or failure and Vancomycin resistant cocci
D. Osteomyelitis(Hospital or Community Acquired)
• Aggressive surgical resection of infected bone and soft tissue should be performed as soon as possible.
• Peripheral vascular sufficiency should be established immediately and a vascular consult ordered if there are questions as to peripheral vascular diseases.
• Once MRSA has been positively identified, the patient should be placed on a six-week course of Vancomycin with weekly monitoring of peaks and troughs with BUN and Creatinine.
• Vancomycin is only delivered by IV, and a PICC will need to be ordered for long-term therapy.
• Vancomycin should be adjusted to maintain therapeutic levels and to avoid toxic response such as nephrotoxicity, ototoxicity, and thrombocytopenia.
• Zyvox* may be used in lieu of Vancomycin in the cases of renal insufficiency or failure or Vancomycin resistant enterococci. * Zyvox PO or IV requires prior authorization with Medical Director review. |
