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Pharmacology of antimicrobial agents for treatment of methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococcus

Richard H Drew, PharmD, MS, FCCP, FIDP
Section Editors
David C Hooper, MD
Sheldon L Kaplan, MD
Deputy Editor
Elinor L Baron, MD, DTMH


The pharmacologic properties of alternatives to vancomycin for use in treatment of invasive infections due to methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococcus (VRE) will be reviewed here. The topic discusses use of the following drugs for monotherapy: daptomycin, linezolid, ceftaroline, telavancin, dalbavancin, oritavancin, tedizolid, tigecycline, and quinupristin-dalfopristin.

Issues related to the role of these agents for treatment of specific infections are discussed in detail separately. (See "Methicillin-resistant Staphylococcus aureus (MRSA) in adults: Treatment of bacteremia" and "Treatment of enterococcal infections".)


Issues related to vancomycin are discussed separately. (See "Vancomycin: Parenteral dosing, monitoring, and adverse effects in adults".)


Daptomycin is a cyclic lipopeptide that is active against gram-positive organisms including streptococci, enterococci (including vancomycin-resistant enterococci [VRE]), methicillin-sensitive S. aureus (MSSA), and methicillin-resistant S. aureus (MRSA) [1,2]. While S. aureus isolates with complete or intermediate resistance to vancomycin in vitro have maintained susceptibility to daptomycin, MRSA isolates with increased minimum inhibitory concentrations (MICs) or prior exposure to vancomycin may also exhibit reduced susceptibility to daptomycin [3,4]. However, elevations in vancomycin MICs have not been useful in predicting outcomes in daptomycin-treated patients [5,6].

Daptomycin is US Food and Drug Administration (FDA) approved for the treatment of adults with complicated skin and skin structure infections due to gram-positive pathogens, for bacteremia with or without right-sided endocarditis in adults due to S. aureus, and for S. aureus bacteremia in pediatric patients [7,8]. Clinical experience with use of daptomycin for other forms of infections due to MRSA and VRE and experience in pediatric patients has been described [9,10].

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Literature review current through: Nov 2017. | This topic last updated: Nov 30, 2017.
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