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Several newer drugs have been developed\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-4df1930e-7fff-0147-311e-768426b622a2\">[00:00:30]\u003C\u002Fb> recently to specifically target these resistant gram-positive strains. Linezolid and new tedizolid are ribosomal protein inhibitors. They bind to the ribosome and prevent the initiation of protein synthesis. The pharmacokinetics of tedizolid allow for once-daily dosing instead of twice daily required for linezolid. The principal uses for these agents is for infection suspected or proven\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-4df1930e-7fff-0147-311e-768426b622a2\">[00:01:00] \u003C\u002Fb>to be due to resistant gram-positive pathogens such as MRSA and VRE. This may include skin and soft tissue infections and community or hospital-acquired pneumonia with or without bacteria. Because of bone marrow suppression and thrombocytopenia, peripheral and optic neuropathy and lactic acidosis, these agents are generally for short term use. Fewer low platelet\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-4df1930e-7fff-0147-311e-768426b622a2\">[00:01:30]\u003C\u002Fb> counts and gastrointestinal side effects have been reported with tedizolid than with linezolid which aligns well with antimicrobial stewardship principles. linezolid therapy should ordinarily be prescribed in a hospital setting after examination by an infectious disease specialist. Part of the reason for an ID consultation is related to the potential toxicity of the compound. Linezolid therapy remains relatively\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-4df1930e-7fff-0147-311e-768426b622a2\">[00:02:00] \u003C\u002Fb>expensive. Inappropriate use may induce the development of high-level linezolid resistance for mutations or acquisition of a resistance plasmid. In general, linezolid should be reserved for the treatment of MRSA infections as an alternative glycopeptides. Daptomycin is a large molecule that can accumulate in the cell membranes of susceptible gram-positive organisms leading the membranes\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-4df1930e-7fff-0147-311e-768426b622a2\">[00:02:30]\u003C\u002Fb> to become porous or leaky and osmotically unstable and eventually leading to cell death. Daptomycin is a parenteral agent useful for staphylococcal bacteremia of unknown source especially MRSA and for right-sided infective endocarditis. It can also be used for complicated skin and soft tissue infections especially those resulting from suspected resistant gram-positive bacteria such as MRSA.\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-4df1930e-7fff-0147-311e-768426b622a2\">[00:03:00] \u003C\u002Fb>It should not be used for pneumonia due to gram-positive organisms because it is inactivated by lung surfactant. Skeletal muscle toxicity and immune thrombocytopenia are the most common side effects associated with daptomycin. Patients taking this drug should undergo weekly monitoring of their creatine phosphokinase levels. The drug should be discontinued if the CPK levels rise more than 10 fold above normal or if a patient shows symptoms\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-4df1930e-7fff-0147-311e-768426b622a2\">[00:03:30] \u003C\u002Fb>of myopathy and has a CPK level over 1000 IU \u002F L. 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