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MRSA Bacteraemia — SCE Infectious Diseases MCQ

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HardAntimicrobial StewardshipMRSA BacteraemiaSCE Infectious Diseases

A patient with MRSA bacteraemia develops immediate anaphylaxis during correctly administered intravenous vancomycin, distinct from a rate-related infusion reaction. Renal function is normal and lung infection has been excluded. Which alternative is supported as first line by the UK MRSA guideline?

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Correct answer: A — Use linezolid 600 mg twice daily as the alternative first-line agent when vancomycin is contraindicated

The best answer is “Use linezolid 600 mg twice daily as the alternative first-line agent when vancomycin is contraindicated”. True immediate vancomycin anaphylaxis is a contraindication to rechallenge. The UK MRSA guideline names linezolid 600 mg twice daily as the alternative first-line treatment for MRSA bacteraemia when vancomycin cannot be used. Rifampicin combinations and oral co-trimoxazole are not routine initial therapy; daptomycin may be considered in a different recommendation position.

Reference: UK MRSA treatment guideline: https://academic.oup.com/jacamr/article/3/1/dlaa114/6127118