mrsa standard
A glycopeptide antibiotic that is the gold standard for MRSA and resistant Gram-positive infections. Large molecule (poor tissue penetration in lungs/CNS compared to Linezolid).
- Mechanism: Inhibits cell wall synthesis (binds D-Ala-D-Ala).
- Spectrum: Gram Positives ONLY. (MRSA, MSSA, Strep, Enterococcus, C. diff - PO only).
dosing & monitoring
- Loading: 25-30 mg/kg (actual body weight) for critically ill.
- Maintenance: 15-20 mg/kg q8-12h (adjust for renal function).
- Monitoring:
- Trough Level: Draw 30 mins before 4th dose.
- Target: 10–15 mg/L (Cellulitis/UTI) vs 15–20 mg/L (Osteo/Endocarditis/Meningitis/Pneumonia).
adverse effects
- Nephrotoxicity: Dose-dependent ATN. Risk with Pip-Taz, CT contrast, diuretics.
- “Red Man Syndrome” (Vancomycin Flushing Reaction):
- Mechanism: Direct mast cell degranulation (Histamine) - NOT an allergy.
- Trigger: Rapid infusion rate.
- Mgmt: Stop infusion, give antihistamines, restart at half rate.
- Ototoxicity: Rare.