Do you routinely recommend transition to dual PO antibiotic coverage for strep species and MRSA, for patients with purulent cellulitis and in the absence of culture data?

I use mostly Linezolid because:

• It’s now much cheaper.
• Even if on serotonin drugs, I can half the serotonin dose while they are on it.
• Covers pretty much all Strep and Staph, including MRSA.
• Protein synthesis inhibition may reduce toxins (like clinda in Strep fasciitis).
• There is no renal dose adju...

I typically do cover both Strep and MRSA- Bactrim + 1st generation cephalosporin (e.g., Keflex or cefirdoxil) is a good combo. Single-drug options include Clindamycin and Doxycycline. Linezolid is also a good single-drug option.

The Infectious Diseases Society of America recommends empiric MRSA coverage for non-purulent cellulitis when specific risk factors are present, including penetrating trauma, evidence of MRSA infection elsewhere, nasal colonization with MRSA, injection drug use, or systemic inflammatory response synd...

I use linezolid for many of these scenarios. Cost Plus Drugs offers 30 tablets for about $26 as of today, yet patients may pay hundreds depending on their insurance and pharmacy. I discuss this with my patients and basically tell them to call me if the pharmacy charges them hundreds of dollars.

Sero...