- 2 yr old admitted to ent department with fever pain nose. no h/o trauma. o/e septal hematoma lt. this was drained and a pediatric consultation was requested.being put on antibiotics, we suggested to continue antibiotics , and to do pt aptt. culture from the drained liquid being already sent. a middle of the night consultation was felt to be a precaution than a necessity. 3 days later review results showed MRSA sensitive to linezolid
- How do you treat MRSA- ?
- Skin and soft tissue infections are by far the most common clinical manifestations of S. aureus infections in children and account for approximately 85 to 95% of infections caused by this organism. Abscesses, furuncles, carbuncles and folliculitis are the predominant skin infections. Cellulitis is also commonly caused by S. aureus. The skin infections,especially those caused by CA-MRSA isolates, can be quite severe and necrotic appearing and can be confused with spider or other insect bites. The skin and soft tissue infections caused by CA-MRSA are more severethan those caused by CA-MSSA isolate
- The resistance of a S. aureus strain to methicillin means that no BETA-lactam antibiotics are effective in treating infections caused by that strain. Trimethoprim-Sulfame-thoxazole (TMP–SMX) and doxycycline are commonly recommended for treating CA-MRSA SSTIs.
- The choice of antibiotic and the route of administration should be governed by the severity of the infection. For outpatients following abscess incision and drainage, where the only issue is possible surrounding cellulitis,TMP–SMX or doxycycline are good choices. Linezolid is another option for outpatient oral therapy. Seven days of therapy is usually adequate for abscesses that have been drained, although 10 to 14 days of treatment aregenerally recommended for cellulitis. Patients with severe or complicated SSTIs requiring hospitalization should receive intravenous antibiotic
Δ Trimethoprim– Oral/IV Base dose on TMP: 8-12 mg TMP (andsulfamethoxazole 40-60 mg SMX) per kg/day in 2 doses; not to exceed adult dose
Δ Fluoroquinolones Oral/IV 10 mg/kg every 8 hours or 15 mg/kg very 12 hours
Δ Linezolid Oral/IV <12 years 10 mg/kg every 8 hours >12 years 600 mg every 12 hours
Δ Minocycline Oral 4 mg/kg for the first dose, followed by 2 mg/kg. The dose is usually given twice a
day for up to 15 days
Δ Clindamycin Oral/IV 20 to 40 mg/kg/day divided every 6 or 8 hours.
Δ Quinupristin/dalfopristin IV 7.5 mg/kg every 8 hours
Δ Teicoplanin IV/IM 10 mg/kg every 12 hourly for first three doses, then 6 mg/kg/day
Δ Vancomycin IV 40 mg/kg/day
Δ Daptomycin IV 4 mg/kg once/day
Δ Tigecycline IV No data to support use in children younger than 18 years old
Superintendent, ICH.