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Prevention of MSSA Bacteremia and treatment with Nafcillin and Ceftriaxone




Methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia is associated with high morbidity and mortality. Usually, antistaphylococcal penicillins (ASPs) have been considered the agents of choice for the treatment of MSSA bacteremia. 

Optimal medication therapy for MSSA infections is unclear. Current standard of care consists of nafcillin, oxacillin and cefazolin. Ceftriaxone has advantage as a once-daily outpatient regimen. (1)

Current evidence suggests there is no difference in efficacy between ceftriaxone and ASPs for MSSA infection, with a lower risk of toxicity with ceftriaxone. Ceftriaxone is a good option for definitive therapy of MSSA infection. (1)

Real time patient medications:

Diagnosis: Back pain, sepsis due to MSSA bacteremia and Lumbar spine abscess.

Nafcillin 10 G Vial (Nafcil) 12gram/1.2vial(s) in Sodium Chloride 0.9% 500 mL, Infuse 12 gm over 24 Hours intravenously Every 24 Hours, Rate: 20.8 mL/Hour GIVE CEFTRIAXONE IV FIRST THEN START NAFCILLIN INFUSION CONTINUE FOR EIGHT WEEKS. DC ON SEPTEMBER 9, 2022 Indication: MSSA: BACTEREMIA

CefTRIAXone 2 G Vial (Rocephin) 2gram/1vial(s) in Sodium Chloride 0.9% 50mL, Infuse 2 gm over 30 Minutes intravenously Every 24 Hours, Rate: 100 mL/Hour CONTINUE FOR SIX WEEKS. DC ON AUGUST 29, 2022 *DOCUMENT FLUSH BEFORE AND AFTER ACCESS* Indication: MSSA: BACTEREMIA

oxyCODONE IR (OxyIR) Give 5 mg (1 tablet(s)) by mouth Every Four Hours PRN Look Alike Sound Alike Medication Indication: moderate pain (4-6)
Lidocaine 4% Patch (Salonpas) Apply 1 patch(es) topically Daily

Mirabegron ER (Myrbetriq) Give 50 mg (1 tablet(s)) by mouth Daily
Heparin 5000 Unit/mL Vial (heparin SODIUM) Inject 5000 unit (1 mL) subcutaneously Every Eight Hours Look-Alike/Sound-Alike *High Alert*

Preventing strategies for MSSA infection: 

Wash hands; wear gloves; keep wounds covered; keep personal items like towels, sheets and razors separate

References:

1. Yetmar ZA, Razi S, Nayfeh T, Gerberi DJ, Mahmood M, Abu Saleh OM. Ceftriaxone versus antistaphylococcal antibiotics for definitive treatment of methicillin-susceptible Staphylococcus aureus infections: a systematic review and meta-analysis. Int J Antimicrob Agents. 2022 Jan;59(1):106486. doi: 10.1016/j.ijantimicag.2021.106486. Epub 2021 Nov 26


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