UMEM Educational Pearls

Category: Critical Care

Title: Vancomycin Alternatives

Keywords: Vancomycin, Daptomycin, Linezolid, MRSA, gram positive, infections, sepsis, pneumonia (PubMed Search)

Posted: 4/12/2011 by Haney Mallemat, MD
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Vancomycin is often started empirically for gram-positive and MRSA coverage. Although effective and generally well-tolerated, emerging resistance and side-effect profiles limit its use in some patients. Two alternatives are Linezolid and Daptomycin.



  • 600 mg IV every 12 hours
  • No renal dosing
  • Better lung penetration in pneumonia (compared to Vancomycin)
  • Side effects: Serotonin Syndrome (w/ concurrent MAOIs), hypersensitivity reaction, and myelosuppresssion




  • 4 mg/kg IV once daily (skin/subcutaneous tissues infection), 6 mg/kg IV once daily (bacteremia or endocarditis), or 6-8mg/kg IV once daily (bacteremia with intravascular line)
  • Renally dosed by altering administration frequency; no change in dose.
  • NEVER use for pneumonia; pulmonary surfactant binds and inactivates drug.
  • Side effects: Reversible rhabdomyolysis (requires weekly CPK levels)


Alder, J. The Use of Daptomycin for Staphylococcus Aureus Infection in the Critical Care Medicine. Crit Care Clin 24(2008); 349-363.