How are you treating MRSA?

**Piper** · 07-12-2012, 09:09 AM

For those who have prescribed it, how well is Rifampin tolerated? I have never written for it and had a well-seasoned ER PA tell me it really "tears a patient's stomach up".

**surgblumm** · 07-12-2012, 01:04 PM

Great forum. You guys have more responses to intelligent clinical question than I have seen at any other site. Kudos to Michael.
Bob

**True Anomaly** · 07-12-2012, 01:43 PM

Originally Posted by Piper

For those who have prescribed it, how well is Rifampin tolerated? I have never written for it and had a well-seasoned ER PA tell me it really "tears a patient's stomach up".

I don't know about the actual physical tolerance of Rifampin because I've never prescribed it outside of TB, but In the October 2010 issue of Emergency Medicine Practice, entitled "Emergency Department Infections In The Era of Community-Acquired MRSA", Rifampin is discussed as adjuvant therapy when treating MRSA. They make quick to mention that it should never be used as monotherapy, but I think we all know that. What they also mention though is that it develops resistance rapidly, as well as citing a study that showed in-vitro evidence of an antagonistic effect when combining Rifampin with Bactrim/Septra.

**Hemegroup** · 07-12-2012, 04:51 PM

have had fine success with doxy

**browndog** · 07-12-2012, 11:54 PM

Group that I work for set protocols as I&D (if fluctuant) and Bactrim DS + Keflex x 10 days. Always culture.

**EMEDPA** · 07-13-2012, 11:53 AM

Originally Posted by browndog

Group that I work for set protocols as I&D (if fluctuant) and Bactrim DS + Keflex x 10 days. Always culture.

I agree that c+s is always best however in our pt population(inner city e.d.) this isn't cost effective. many of our pts can't afford a 400 dollar test that likely won't change their tx course. that being said I always get a c+s on kids, the elderly, diabetics, and anyone immunocompromised but the typical 22 yr old otherwise healthy IV meth user is mrsa most of the time and if it is just strep, non-mrsa staph, or a tick borne infection, doxy for 4 dollars will cover it, not to mention the latent chlamydia often seen in this pt population.