Methicillin Resistant Staphylococcus aureus (MRSA) Treatment with Daptomycin

 Treatment of Methicillin Resistant Staphylococcus aureus (MRSA) infections is difficult due to limited antibiotic options. The choice of treatment depends on the antibiotic susceptibility of the pathogen. MRSA accounts for more than 60 per cent of S. aureus infections (1). Daptomycin is a good alternative to vancomycin in the treatment of MRSA infections where nephrotoxicity is a concern.

Real Time Patient:

Hypertension, MRSA bacteremia, Opioid dependence, Discitis, vertebral osteomyelitis, paraspinal abscess.

Heparin 5000 Unit/mL Vial (heparin SODIUM) Inject 5000 unit (1 mL) subcutaneously Twice Daily Look-Alike/Sound-Alike *High Alert*

DAPTOmycin 500 mg Vial (Cubicin) 840mg/1.68vial(s) in Sodium Chloride 0.9% 100mL, Infuse 840 mg over 30 Minutes intravenously Every 24 Hours, Rate: 200 mL/Hour *DOCUMENT FLUSH BEFORE AND AFTER ACCESS* Indication: MRSA Vertebral Osteomyelitis

DiphenhydrAMINE/Zinc 2% Cream (Benadryl Cream) Apply topically Twice Daily PRN Apply around back incisions to reduce itching Indication: pruritus of skin

Bacitracin Zinc 500 unit/G Oint 28G (Bacitracin Zinc) Apply topically Every 12 Hours Apply Bacitracin ointment every 12 hours and as needed to scabs/irritated skin to Left chest. Encourage patient not to scratch skin. Monitor for s/sx infection. Indication: Left chest - skin irritation, scabbed

oxyCODONE IR (OxyIR) Give 30 mg (1 tablet(s)) by mouth Every Three Hours Recommended dose by patient's primary pain management physician.

Naloxone 0.4 mg/mL Vial (Narcan) Inject 0.4 mg (1 mL) IV push every 15 minutes PRN Indication: opioid-induced respiratory depression

Calcium Carbonate Chew (Tums) Give 500 mg (1 tablet(s)) by mouth Twice Daily

Cholecalciferol (Vitamin D3) Give 5000 unit (1 tablet(s)) by mouth Daily

Zolpidem (Ambien) Give 5 mg (1 tablet(s)) by mouth At Bedtime PRN 1ST LINE THERAPY Indication: insomnia

rifAMPin (rifAMPin) Give 300 mg (1 capsule(s)) by mouth Twice Daily STOP DATE: 09/01/2022 Indication: MRSA vertebral osteomyelitis

Acetaminophen (Tylenol) Give 650 mg (2 tablet(s)) by mouth Every Eight Hours PRN FOR PAIN LEVEL 1-3 OR FEVER OVER 100.5F;Max dose acetaminophen 4000 mg in 24 hrsfrom all sources Indication: pain

Promethazine (Phenergan) Give 12.5 mg ( 1/2 tablet(s)) by mouth Every Four Hours PRN 2ND LINE THERAPY Indication: nausea and vomiting

Lactulose 20 G/30 mL Oral Sol (Enulose) Give 20 gram (30 mL) by mouth Every Eight Hours PRN 3RD LINE THERAPY Indication: constipation

Bisacodyl (Dulcolax) Give 10 mg (2 tablet(s)) by mouth Daily PRN 2ND LINE THERAPY Indication: constipation

Simethicone (Mylicon Chewable) Give 120 mg (1.5 tablet(s)) by mouth Four Times Daily PRN Indication: GAS

Senna (Senna Lax) Give 17.2 mg (2 tablet(s)) by mouth Twice Daily

Polyethylene Glycol 3350 (Miralax) Give 17 gram (1 packet(s)) by mouth Daily Mix with 8 oz of water or beverage of choice.

Lisinopril (Prinivil) Give 20 mg (1 tablet(s)) by mouth Daily

Daptomycin FDA approved indications:

1. Complicated skin and skin structure infections (cSSSI) 

2. Staphylococcus aureus bloodstream infections (bacteremia), including those with right-sided infective endocarditis 

DOSAGE AND ADMINISTRATION

 Recommended dosage regimen for adult patients: 

Creatinine Clearance (CLCR) Dosage Regimen cSSSI For 7 to 14 days. CLCR ≥30 mL/min, give 4 mg/kg once every 24 hours. For CLCR <30 mL/min, including hemodialysis and CAPD, give 4 mg/kg once every 48 hours

S. aureus Bacteremia For CLCR ≥30 mL/min, 6 mg/kg once every 24 hours and for CLCR <30 mL/min 6 mg/kg once every 48 hours.

Administered following hemodialysis on hemodialysis days. (2)

ADVERSE REACTIONS

The most clinically significant adverse reactions observed with CUBICIN 4 mg/kg (cSSSI trials) and 6 mg/kg (S. aureus bacteremia/endocarditis trial) were abnormal liver function tests, elevated CPK, dyspnea, and pneumonia. (2)

References:

1. National Nosocomial Infections Surveillance System. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control. 2004 Dec;32(8):470-85. doi: 10.1016/S0196655304005425. PMID: 15573054.
2. https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/021572s038lbl.pdf