Spectrum: Local Antimicrobial Stewardship, for Providence Health Care

Hemodynamically unstable or severe infection

Initial Empiric Treatment

Vancomycin 25 mg/kg IV loading dose

Subsequent dosing frequency depends on renal function

View vancomycin nomogram

AND

Cloxacillin 2g IV Q4h until susceptibility results are available ⁴

Duration of Therapy

Treat for a minimum of 2 weeks after first negative blood culture if patient has no complicating factors

  • Evidence of endocarditis or metastatic infection

  • Presence of prostheses

  • Persistent fever 72 hours after antibiotic initiation

  • Persistent S.aureus bacteremia 4 days after appropriate antibiotic initiation

Longer treatment duration is needed for patients who have complicated S.aureus bacteremia to prevent relapse

Monitoring

References

(4) Incanci A et al. Eur J Clin Microbiol Infect Dis. 2013