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