From the Research
The treatment for recurrent MRSA bacterial sinusitis should prioritize tedizolid as the first-line antibiotic therapy due to its superior in vitro activity and efficacy compared to other antibiotics, as shown in recent studies 1, 2.
Treatment Approach
The management of recurrent MRSA bacterial sinusitis involves a combination of antibiotics, nasal irrigation, and possibly surgical intervention.
- Antibiotic therapy options include tedizolid, which has shown superior efficacy in treating MRSA infections, with a daily dose of 200mg once daily for 6 days 1, 2.
- Nasal irrigation with saline solution should be performed 2-3 times daily to help reduce bacterial load and promote healing.
- Adding mupirocin nasal ointment (applied inside nostrils twice daily for 5-7 days) can help eradicate colonization, as supported by a study on mupirocin irrigations for MRSA exacerbations of chronic rhinosinusitis 3.
Considerations
- For persistent cases, consultation with an otolaryngologist is recommended to evaluate for surgical drainage or functional endoscopic sinus surgery.
- Decolonization protocols may be necessary, including daily chlorhexidine body washes and changing bed linens frequently, to prevent recurrence and reduce the risk of transmission.
- MRSA is particularly challenging to treat because it's resistant to many common antibiotics, including methicillin and other beta-lactams, making tedizolid a valuable option due to its effectiveness against MRSA, as demonstrated in a network meta-analysis comparing tedizolid with other antibiotics for the treatment of acute bacterial skin and skin structure infections caused by MRSA 1, 2.
Multidisciplinary Approach
Long-term management often requires a multidisciplinary approach with infectious disease specialists and ENT doctors to prevent chronic infection and address any underlying conditions that may be contributing to the recurrence of MRSA sinusitis.
- This approach should include regular follow-up appointments to monitor the patient's condition and adjust the treatment plan as needed.
- The use of outpatient intravenous antibiotics, such as vancomycin or daptomycin, may be considered for severe cases or those that do not respond to oral antibiotic therapy, as supported by a retrospective chart review of patients treated for MRSA sinusitis with outpatient intravenous antibiotics 4.