Refer to MRSA decolonisation guideline in the Multidrug Resistant Organisms (MDRO): Guidelines for control, and in Hospital HealthPathways.
mupirocin 2% ointment |
Apply to nose (both sides) twice a day with clean cotton buds for 7 days |
OR, if mupirocin resistance:
povidone-iodine 10% ointment |
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 if MRSA colonised, or previously MRSA colonised and current status unknown.
vancomycin |
IV 1 g (< 70 kg), 1.5 g (70 – 100 kg) or 2 g (>100 kg). See surgical antimicrobial prophylaxis. |
trimethoprim+sulfamethoxazole |
PO 160 mg/800 mg to 320 mg/1600 mg twice a day |
OR
clindamycin |
PO 450 mg three times a day or IV 600 mg every eight hours |
Use clindamycin alone if susceptible, or add penicillin to above antimicrobials:
benzylpenicillin (Penicillin G) |
IV 1.8 g (3 megaunits) every six hours |
followed by early switch to
phenoxymethylpenicillin (Penicillin V) |
PO 500 mg four times a day |
flucloxacillin |
IV 2 g every six hours |
Mild penicillin allergy
cefazolin |
IV 2 g every eight hours |
Severe penicillin allergy
vancomycin |
See dosing guidelines (use high doses) |
ADD vancomycin to the above regimens (flucloxacillin or cefazolin) until culture and susceptibility results are available:
vancomycin |
See dosing guidelines (use high doses) |
vancomycin |
See dosing guidelines (use high doses) |
Topic Code: 132653