Skip to main content

Table 3 Clinical decision-making for the choice of antibiotic with activity against MRSA according to the severity of disease

From: Treatment of complicated skin and soft-tissue infections caused by resistant bacteria: value of linezolid, tigecycline, daptomycin and vancomycin

severity of infection

characteristics

setting

preferred route

substances

mild

- limited local signs

outpatient

oral

TMP-SMX ± rifampicin

 

- no systemic signs

  

clindamycin*â—Š

 

- no surgery required

  

linezolid*

 

- patient stable

   

moderate

- marked local signs

hospitalized, general ward

initially i.v.

linezolid*

 

- systemic signs measurable

  

tigecycline#

 

- surgery required

  

daptomycin

 

- patient stable

  

vancomycin

   

sequential oral treatment

linezolid*

    

clindamycin* â—Š

    

TMP-SMX ± rifampicin

severe

- massive local and/or systemic signs

inpatient, intensive care

initially i.v.

linezolid*

 

- surgery required

  

daptomycin

 

- patient unstable

  

[bacteremia]

    

tigecycline #

    

[polymicrobial inf.]

    

(vancomycin)

   

sequential oral treatment

linezolid*

    

clindamycin*â—Š

    

TMP-SMX ± rifampicin

  1. * preferred in cMRSA infections
  2. # not indicated in diabetic foot infections
  3. â—Š = if susceptible
  4. TMP-SMX = trimethoprim-sulfamethoxazole
  5. (vancomycin) = to be used only if other drugs are not tolerated or not available