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Vancomycin is often started empirically for gram-positive and MRSA coverage. Although effective and generally well-tolerated, emerging resistance and side-effect profiles limit its use in some patients. Two alternatives are Linezolid and Daptomycin.
Linezolid
- 600 mg IV every 12 hours
- No renal dosing
- Better lung penetration in pneumonia (compared to Vancomycin)
- Side effects: Serotonin Syndrome (w/ concurrent MAOIs), hypersensitivity reaction, and myelosuppresssion
Daptomycin
- 4 mg/kg IV once daily (skin/subcutaneous tissues infection), 6 mg/kg IV once daily (bacteremia or endocarditis), or 6-8mg/kg IV once daily (bacteremia with intravascular line)
- Renally dosed by altering administration frequency; no change in dose.
- NEVER use for pneumonia; pulmonary surfactant binds and inactivates drug.
- Side effects: Reversible rhabdomyolysis (requires weekly CPK levels)
References
Alder, J. The Use of Daptomycin for Staphylococcus Aureus Infection in the Critical Care Medicine. Crit Care Clin 24(2008); 349-363.