Methicillin-resistant S. aureus bacteraemia

Australian Commission on Safety and Quality in Health Care (ACSQHC), 2023

For directed therapy for methicillin-resistant S. aureus (MRSA) bacteraemia in adults, children and neonates, use:

vancomycin intravenously; for initial dosing, see Intermittent vancomycin dosing for noncritically ill adults or Intermittent vancomycin dosing for young infants and children. See advice on duration of therapy. vancomycin vancomycin vancomycin

Vancomycin is the preferred treatment for MRSA bacteraemia because other antibiotics have not been shown to be superior to vancomycin for this indication. Some antibiotics (including teicoplanin and trimethoprim+sulfamethoxazole) have been shown to be inferior to vancomycin when used for initial treatment of MRSA bacteraemia, and should be avoidedPaul, 2015.

For patients who are unable to tolerate vancomycin or if the MRSA isolate has reduced susceptibility to vancomycin (ie minimum inhibitory concentration [MIC] is more than 1 mg/L)Samura, 2022, seek expert advice. Daptomycin or linezolid may be appropriate alternatives to vancomycin on the advice of a clinical microbiologist or infectious diseases physician; however, daptomycin should not be used in patients with staphylococcal pneumonia.