Spectrum: Local Antimicrobial Stewardship, for Markham Stouffville Hospital

Adults - Initial Empiric Therapy

Initial Empiric Therapy

Vancomycin 15-20mg/kg IV Q12H

  • Give initial loading dose of 25-30mg/kg.

  • Target trough of 15-20µg/mL.

  • Dosing for vancomycin is based on actual body weight.

CONSIDER ADDING EITHER

Cloxacillin 2g IV Q4H

Inclusion of targeted MSSA therapy is indicated amongst patients with high morbidity and mortality including severe sepsis, probable endocarditis or presence of a prosthetic or endovascular device

OR

Cefazolin 2g IV Q8H

Inclusion of targeted MSSA therapy is indicated amongst patients with high morbidity and mortality including severe sepsis, probable endocarditis or presence of a prosthetic or endovascular device

Note

Addition of gentamicin or rifampin is not routinely recommended for SAB.