Table 1

Antibiotics currently available for the treatment of serious methicillin-resistant S. aureus infections

Antibiotic

Primary indications

Daily dose^a

Volume of distribution (L/kg)

Elimination half-life (hr)

Protein binding (%)

Main toxicity

Vancomycin

Pneumonia

30 mg/kg/day

0.2 to 1.25

4 to 6

30 to 55

Nephrotoxicity (higher doses)

Skin/soft tissues

Thrombocytopenia

Bacteremia

Linezolid

Pneumonia

600 mg q 12 h

0.5 - 0.6

5

31

Myelosuppression (prolonged duration generally >2 weeks)

Skin/soft tissues

Lactic acidosis

Peripheral and optic neuropathy

Serotonin syndrome

Tigecycline

Skin/soft tissues

100 mg load

7 to 10

37 to 66

71 to 89

Nausea

Intra-abdominal

50 mg q 12 h

Vomiting

Photosensitivity

Daptomycin

Bacteremia

Bacteremia: 6 mg/kg q 24 h

0.09

8 to 9

92

Muscle toxicity

Skin/soft tissues

Skin/soft tissues: 4 mg/kg q 24 h

CPK elevation

Quinupristin/dalfopristin

Skin/soft tissues

7.5 mg/kg q 8 h (via central vein)

0.56 to 0.98

0.54 to 1.14

11 to 78

Phlebitis

Arthralgias and myalgias

Ceftobiprole^b

Skin/soft tissues

500 mg q 8 h

0.25 to 0.30

3 to 4

16

Allergic reactions

Ceftaroline^c

Skin/soft tissues Pneumonia

600 mg q 12 h

0.22 to 0.25

2.5 to 3

18

Allergic reactions

Dalbavancin^c

Skin/soft tissues

1,000 mg day 1

0.011

147 to 258

93

Nausea

500 mg weekly

Vomiting

Oritavancin^c

Skin/soft tissues

1.5 to 3 mg/kg q 24 h

0.65 to 1.92

195

90

Nausea

Vomiting

Telavancin^c

Skin/soft tissues Pneumonia

7.5 to 10 mg/kg day

0.1

7 to 9

93

Renal thrombocytopenia

Iclaprim^d

Skin/soft tissues

0.8 mg/kg q 12 h

1.15

2.5 to 4.1

93

^aDaily dose listed assumes normal kidney and liver function. ^bNot approved for clinical use in the US. Greater risk of clinical failure in ventilator-associated pneumonia compared to vancomycin plus ceftazadine. ^cNot approved for clinical use in the US at the time of writing. ^dNot approved for clinical use in the US. Failed to demonstrate non-inferiority against linezolid for treatment of complicated skin and skin structure infection. CPK, creatine phosphokinase.

Skrupky et al. Critical Care 2009 13:222   doi:10.1186/cc8028