From the Guidelines
For skin infections with suspected or confirmed MRSA, the recommended antibiotics include linezolid, trimethoprim-sulfamethoxazole (TMP-SMX), a tetracycline (doxycycline or minocycline), or tedizolid, as suggested by the most recent guidelines 1.
Key Considerations
- The choice of antibiotic depends on the severity of the infection, patient allergies, and local resistance patterns.
- Incision and drainage is crucial for abscesses, and may be sufficient without antibiotics for small, uncomplicated lesions.
- Good wound care, including keeping the area clean and covered, is essential alongside antibiotic therapy.
Antibiotic Options
- Oral antibiotics: linezolid, TMP-SMX, doxycycline, or tedizolid.
- Intravenous antibiotics: daptomycin, linezolid, ceftaroline, dalbavancin, vancomycin, tigecycline, or tedizolid.
Duration of Therapy
- 7-14 days of therapy is recommended, but should be individualized based on the patient's clinical response 1.
Important Notes
- MRSA skin infections often present as painful red bumps resembling spider bites that may develop into abscesses.
- These recommendations target MRSA's resistance to beta-lactam antibiotics like methicillin, penicillins, and cephalosporins by using alternative mechanisms of action.
- The use of rifampin as a single agent or as adjunctive therapy for the treatment of SSTI is not recommended 1.
From the FDA Drug Label
SIVEXTRO is an oxazolidinone-class antibacterial indicated in adult and pediatric patients 12 years of age and older for the treatment of acute bacterial skin and skin structure infections (ABSSSI) caused by susceptible isolates of the following Gram-positive microorganisms: Staphylococcus aureus (including methicillin-resistant [MRSA] and methicillin-susceptible [MSSA] isolates) The cure rates in microbiologically evaluable patients with MRSA skin and skin structure infection were 26/33 (79%) for linezolid-treated patients and 24/33 (73%) for vancomycin-treated patients Methicillin-resistant S aureus2/3 (67)0/0 (-) Methicillin-resistant S aureus12/17 (71)2/3 (67)
Antibiotic Options for Skin Infections to Cover MRSA:
- Tedizolid (SIVEXTRO): effective against MRSA, with a cure rate of 67% in a small number of patients 2
- Linezolid (ZYVOX): effective against MRSA, with cure rates of 79% and 71% in two separate studies 3
Key Considerations:
- The choice of antibiotic should be based on local epidemiology and susceptibility patterns, as well as the specific characteristics of the patient and the infection.
- It is essential to use antibiotics judiciously and only when necessary to reduce the development of drug-resistant bacteria.
From the Research
Antibiotic Options for Skin Infections Caused by MRSA
- The choice of antibiotic for treating skin infections caused by MRSA should be guided by the site and type of infection, as well as the presence of risk factors for hospital-acquired or community-associated MRSA 4.
- For community-associated MRSA (CA-MRSA) infections, most strains remain susceptible to ciprofloxacin, clindamycin, gentamicin, and trimethoprim/sulfamethoxazole, although resistance to clindamycin can emerge during treatment 4.
- For hospital-acquired MRSA (HA-MRSA) infections, vancomycin has been the reference standard, but alternative agents such as linezolid, daptomycin, and tigecycline may be effective 4, 5.
Recommended Antibiotics for MRSA Skin Infections
- Linezolid is likely the drug of choice for treating complicated MRSA skin and soft tissue infections (SSTIs) 5, 6.
- Tedizolid has shown potential advantages over linezolid, including once-daily dosing and increased tolerability, but its high cost may limit its adoption 7.
- Daptomycin and vancomycin are also effective options for treating MRSA SSTIs, although vancomycin may be less effective for infections with higher MIC values 5, 6.
Network Meta-Analysis of Antibiotic Efficacy
- A network meta-analysis of 20 randomized controlled trials found that linezolid was superior to vancomycin in improving clinical and microbiological success in MRSA-caused SSTIs 6.
- The analysis also found that linezolid had the highest probability of being ranked best in terms of clinical and microbiological success, without significant differences in safety compared to other antibiotics 6.