هو انت لو عندك culture ومزرعة MRSA Sensitive to vancomycin - linezolid اختار ايه؟ As general rule Vancomycin is the gold standard for MRSA infections بس فى شويه نقط نخلى بالنا منهم Vancomycin: 1 - nephrotoxic 2- used for bacteremia and endocarditis as it is bactericidal and high conc in blood 3-oral form used for severe C. diff infections 4-need loading dose in severe infection 5- need dose adjustment according to GFR 6-need trough concentration Linezolid: 1- not nephrotoxic and no dose adjustment in renal failure 2- not preferred to be used for bacteremia and endocarditis as it is bacteriostatic and low blood concentration 3- SUPERIOR for MRSA pneumonia than VANCOMYCIN due to better lung penetration and antitoxic effect 4- Superior to Vancomycin in skin-soft tissue infections due to high penetration and antitoxic effects 5- cause bone marrow suppression mainly thrombocytopenia which may be reversed by pyridoxine (vit b 6) 6- high risk of serotonin syndrome if combined with SSRI or opioids و مريض مات بسبب كدا متخيل ! 7- Risk for mitochondrial toxicity causing lactic acidosis 8- risk for peripheral neuropathy و على هذا الاساس هتختار ادى ايه بالظبط مش منطقى يكون مريض عنده thrombocytopenia مثلا و أبدا معاه zyvox و من منطقى يكون مريض برضو دخل ف ckd و اديله vanco مش بنقول انه ممنوع بس بنقول اننا لازم نبص عل risk benefit ratio #إذكروا_الله ❤ #صلى_على_الحبيب_قلبك_يطيب ❤