A 48 yo male S/P gun shot wound to the head 4 days prior remains intubated curre

Question

A 48 yo male S/P gun shot wound to the head 4 days prior remains intubated currently in the Surgical Intensive Care Unit. Postoperatively, he remains afebrile and clinically stable. His ventilator requirements have not changed and the nurse has not reported any significant changes in secretions. Sputum gram stain results report rare WBCs and moderate gram-positive cocci in clusters. The sputum culture grows S. aureus (S to TMP-SMX, vancomycin, clindamycin and R to methicillin, cefazolin, imipenem, ceftriaxone). His SCr is 1.0 mg/dL and he has NKDA. This morning’s CXR reveals no infiltrates or effusions. The patient is currently receiving imipenem [Primaxin] 500 mg IV every 6 hours for empiric treatment of pneumonia.Which of the following is (are) the most appropriate recommendation(s) at this time? Check all that may apply.

Add vancomycin

Discontinue imipenem

Add clindamycin

Continue imipenem

Explanation / Answer

The appropriate recommendation of the drug among 4 options is: Add Vancomycin

Explanation:

Clindamycin (600 mg IV or orally three times day by day) might be utilized as a contrasting option to vancomycin or linezolid if the disengage is known to be defenseless. Ceftaroline is dynamic against most strains of MRSA yet isn't FDA affirmed for pneumonia caused by S. aureus.

Vancomycin has been prescribed as the treatment of decision for methicillin-safe Staphylococcus aureus (MRSA) pneumonia with a coveted trough convergence of 15 to 20 mg/L.

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