Canterbury DHB

Context

Methicillin Resistant S. aureus (MRSA)

In This Section

Decolonisation protocol

Surgical prophylaxis

MRSA soft tissue infection

Bacteraemia

Decolonisation protocol

Refer to MRSA decolonisation guideline in the Multidrug Resistant Organisms (MDRO): Guidelines for control, and in Hospital HealthPathways.

mupirocin 2% ointment

HMLSchedNZF

Apply to nose (both sides) twice a day with clean cotton buds for 7 days

OR, if mupirocin resistance:

povidone-iodine 10% ointment

HMLSchedNZF

Apply to nose (both sides) twice a day with clean cotton buds for 7 days

AND EITHER

chlorhexidine gluconate 4% solution

(first-line)

Use once a day as a body wash for showering and twice a week for hair washing for 7 days

OR, for patients intolerant of chlorhexidine and those with sensitive or fragile skin:

octenidine 0.3% wash lotion

(second-line)

Use once a day as a body wash for showering and twice a week for hair washing for 7 days

Surgical prophylaxis

Surgical prophylaxis if MRSA colonised, or previously MRSA colonised and current status unknown.

vancomycin

HMLSchedNZFPMLnoids

IV 1 g (< 70 kg), 1.5 g (70 – 100 kg) or 2 g (>100 kg). See surgical antimicrobial prophylaxis.

MRSA soft tissue infection

trimethoprim+sulfamethoxazole

HMLSchedNZFPMLnoids

PO 160 mg/800 mg to 320 mg/1600 mg twice a day

OR

clindamycin

HMLSchedNZFPMLnoids

PO 450 mg three times a day or IV 600 mg every eight hours

Co-infection with group A streptococcus

Use clindamycin alone if susceptible, or add penicillin to above antimicrobials:

benzylpenicillin

HMLSchedNZFPMLnoids

(Penicillin G)

IV 1.8 g (3 megaunits) every six hours

followed by early switch to

phenoxymethylpenicillin

HMLSchedNZFPML

(Penicillin V)

PO 500 mg four times a day

Bacteraemia

Suspected S. aureus bacteraemia (MRSA status unknown)

flucloxacillin

HMLSchedNZFPMLnoids

IV 2 g every six hours

Mild penicillin allergy

cefazolin

HMLSchedNZFPMLnoids

IV 2 g every eight hours

Severe penicillin allergy

vancomycin

HMLSchedNZFPMLnoids

See dosing guidelines (use high doses)

Suspected S. aureus bacteraemia with risk factors for MRSA colonisation

ADD vancomycin to the above regimens (flucloxacillin or cefazolin) until culture and susceptibility results are available:

vancomycin

HMLSchedNZFPMLnoids

See dosing guidelines (use high doses)

Confirmed MRSA bacteraemia

vancomycin

HMLSchedNZFPMLnoids

See dosing guidelines (use high doses)

Information about this Canterbury DHB document (132653):

Document Owner:

Not assigned (see Who's Who)

Last Updated:

March 2018 (Methicillin Resistant S. aureus (MRSA))

Next Review Due:

March 2021

Keywords:

Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document.

Topic Code: 132653