Version October 2024
| Drug | Adult dose |
| Antibiotics of choice* | |
| Vancomycin¶ | 15 to 20 mg/kg/dose every 8 to 12 hours |
| DaptomycinΔ | 4 to 6 mg/kg IV once daily |
| Alternative agents | |
| Short-acting agents with parenteral or oral dosing | |
| Linezolid | 600 mg IV (or orally) twice daily |
| Tedizolid | 200 mg IV (or orally) once daily |
| Delafloxacin | 300 mg IV twice daily (or 450 mg orally twice daily) |
| Omadacycline◊ | 100 mg IV once daily (or 300 mg orally once daily) |
| Short-acting agent with parenteral dosing§ | |
| Ceftaroline | 600 mg IV every 12 hours |
| Telavancin | 10 mg/kg once daily |
| Long-acting agents with parenteral dosing | |
| Dalbavancin | Single-dose regimen: 1500 mg once Two-dose regimen: Initial dose 1000 mg, followed by 500 mg dose one week later |
| Oritavancin | 1200 mg IV as a single dose |
MRSA: methicillin-resistant S. aureus; IV: intravenously; AUC: area under the 24-hour time-concentration curve.
* In areas outside the United States where teicoplanin is available, some use it as the drug of choice for initial therapy of gram-positive pathogens, while others favor its use for patients with intolerance to vancomycin.
¶ For severely ill patients, a vancomycin loading dose (20 to 35 mg/kg) is appropriate[1]; within this range, we use a higher dose for critically ill patients. The loading dose is based on actual body weight, rounded to the nearest 250 mg increment and not exceeding 3000 mg. The initial maintenance dose and interval are determined by nomogram (typically 15 to 20 mg/kg every 8 to 12 hours for most patients with normal renal function). Subsequent dose and interval adjustments are based on AUC-guided or trough-guided serum concentration monitoring. Refer to the UpToDate topic on vancomycin dosing for sample nomogram and discussion of vancomycin monitoring.
Δ Dosing of daptomycin for treatment of skin and soft tissue infection is 4 to 6 mg/kg IV once daily; dosing for treatment of bacteremia is at least 6 mg/kg IV once daily. (Refer to the UpToDate topic on treatment of MRSA bacteremia for further discussion.)
◊ A loading dose may be used: 200 mg IV over 60 minutes OR 100 mg IV over 30 minutes twice.
§ Ceftobiprole has broad-spectrum activity against gram-positive and gram-negative organisms and is available in some countries outside the United States.Data from: Lui C, Bayer A, Cosgrove SE, et al. Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis 2011; 52:285.
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