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Reminder of important clinical lesson
Enteral vancomycin and probiotic use for methicillin-resistant Staphylococcus aureus antibiotic-associated diarrhoea
  1. Elizabeth Nicole Sizemore1,
  2. Kenya Maria Rivas2,
  3. Jose Valdes3,
  4. Joshua Caballero4
  1. 1Department of Pharmacy, Rogue Valley Medical Centre, Asante Health System, Medford, Oregon, USA
  2. 2Department of Geriatrics, Nova Southeastern University, Fort Lauderdale, Florida, USA
  3. 3Department of Pharmacy Practice, Baptist Health Care, Pensacola, Florida, USA
  4. 4Department of Pharmacy Practice, Nova Southeastern University, Fort Lauderdale, Florida, USA
  1. Correspondence to Dr Joshua Caballero, jcaballe{at}

A geriatric patient status post intraabdominal surgery presented with persistent diarrhoea and heavy intestinal methicillin-resistant Staphylococcus aureus (MRSA) growth after multiple courses of antibiotic therapy. Additionally, swab cultures of the anterior nares tested positive for MRSA. In order to impede infection and prevent future complications, the patient received a 10-day course of vancomycin oral solution 250 mg every 6 h, 15-day course of Saccharomyces boulardii 250 mg orally twice daily and a 5-day course of topical mupirocin 2% twice daily intranasally. Diarrhoea ceased during therapy and repeat cultures 11 days after initiating therapy demonstrated negative MRSA growth from the stool and nares. Further repeat cultures 5 months later revealed negative MRSA growth in the stools and minimal MRSA growth in the nares. Overall, enteral vancomycin and probiotics successfully eradicated MRSA infection without intestinal recurrence. Although the results were beneficial treating MRSA diarrhoea for our patient, these agents remain highly controversial.

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  • Competing interest None.

  • Patient consent Obtained.

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