These 2 antibiotics can be associated if you look for abroad spectrum within the framework of a probabilistic antibiotic treatment as for example in the case of your patient presenting probably a nosocomial peritonitis by perforing of a hollow organ. No medicinal intéraction is described or waited. The in vitro studies showed that the ertapeneme does not interact with the hepatic cytochromes. The strong activity of the ertapénème on the anaerobic germs makes useless the association with the metronidazole. On the other hand the association in the vancomycine allows to cover an intra-abdominal infection to SARM or entérococcus (except ERV).

The answer to the question about vanco + ertapenem for staph infection is simply: NO. If this staph is Staph. aureus susceptible to cloxacillin, then it should be used instead of vancomycin as cloxacillin is better. There's no need for adding ertapenem to treat staph infection.

For the perforate bowel abscess you should use imipenem or meropenem instead ertapenem as ertapenem doesn't kill Pseudomonas! It is odd if this patient has staph infection! And, carbapenems cover anaerobs, so no need fo metronidazol too!

I agree

Hi everyone,

I think Levette should give more details about the patient. Pediatric or adult? High risk or low risk? Community-acquired or health care-associated infection? If we have this information, then a good reference to find the answer is IDSA guideline (CID 2010) for treatment of "Complicated Intra-abdominal Infection in Adults and Children" [available at: http://cid.oxfordjournals.org/content/50/2/133.full.pdf).

I also have a comment on what Lorena said. First, VRSA is still uncommon (33 cases overall) and have been reported only from USA, India, Iran and Pakistan. (available at: http://journals.lww.com/infectdis/Abstract/publishahead/VanA_Positive_Vancomycin_Resistant_Staphylococcus.99544.aspx). Second, for countries like Iran which VISA/VRSA has been reported, other anti-staphylococcal drugs are expensive and not available in many centers (I think it is also true for India and Pakistan). So, using vancomycin wisely is a better option.

Hi everone

ı think before answering the question; the features of the patient should be reviewed

for example the stay at ICU; the hospital duration , pediatric and adult

İf you consider about staphylococal infections; what about the meticilin and oxacilin resistance;

so in the presence of MRSA; vancomycine would be appropriate

But if you have no positive culture; and the patient is staying at ICU; one should consider possible pseudomonas infections which invanz do not cover

for the positive MRSA or MRSE culture; vancomycine despite the side effects may be preferred instead of teicoplanin and linezolide due to its low cost.