Hemodynamically unstable or severe infection

Initial Empiric Treatment

Vancomycin 25 mg/kg IV loading dose

Subsequent dosing frequency depends on renal function. Continue vancomycin until susceptibility are available.

AND

Cloxacillin 2g IV q4h until susceptibility results are available.

Duration of Therapy

Treat for a minimum of 2 weeks after first negative blood culture if patient has no complicating factors:

Infective endocarditis has been excluded
No implanted prostheses are present
Follow up blood cultures drawn 2-4 days after the initial set are sterile
The patient defervesces within 72 hours of initiation of effective antibiotic therapy
No evidence of metastatic infection is present on examination

Longer treatment duration is needed for patients who have complicated Staphylococcus aureus bacteremia. Strongly consider consultation with Infectious Diseases.