What is the treatment for Methicillin-resistant Staphylococcus aureus (MRSA) skin infections?

From the Guidelines

Treatment for MRSA skin infections should prioritize incision and drainage for cutaneous abscesses, with antibiotic therapy recommended for severe or extensive disease, or when associated with cellulitis, systemic illness, or comorbidities, as outlined in the 2011 clinical practice guidelines by the Infectious Diseases Society of America 1. When it comes to MRSA skin treatment, the primary approach involves a combination of surgical intervention and antibiotic therapy. For cutaneous abscesses, incision and drainage is the primary treatment, with antibiotic therapy playing a secondary role in certain conditions such as severe or extensive disease, rapid progression, or associated cellulitis, signs and symptoms of systemic illness, comorbidities, or immunosuppression 1.

Key Considerations for MRSA Skin Infections

• Incision and drainage is the primary treatment for cutaneous abscesses, with antibiotic therapy recommended for abscesses associated with severe or extensive disease, or rapid progression in the presence of associated cellulitis, signs and symptoms of systemic illness, comorbidities, or immunosuppression 1.
• For outpatients with purulent cellulitis, empirical therapy for CA-MRSA is recommended pending culture results, with options including clindamycin, TMP-SMX, a tetracycline (doxycycline or minocycline), and linezolid 1.
• For hospitalized patients with complicated SSTI, empirical therapy for MRSA should be considered pending culture data, with options including IV vancomycin, linezolid, daptomycin, telavancin, and clindamycin 1.

Antibiotic Options for MRSA Skin Infections

• Oral antibiotic options for empirical coverage of CA-MRSA in outpatients with SSTI include clindamycin, TMP-SMX, a tetracycline (doxycycline or minocycline), and linezolid 1.
• For hospitalized patients, IV vancomycin, linezolid, daptomycin, telavancin, and clindamycin are recommended options for empirical therapy for MRSA 1.

Wound Care and Prevention

• Proper wound care is essential, including incision and drainage of abscesses, keeping the wound clean, and covering it with sterile dressings that are changed regularly 1.
• Patients should practice good hygiene, such as washing hands thoroughly before and after changing dressings, and avoiding sharing personal items like towels and razors to prevent the spread of infection.

From the FDA Drug Label

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 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)

MRSA Skin Treatment Options:

• Linezolid (ZYVOX): 79% cure rate in microbiologically evaluable patients with MRSA skin and skin structure infection 2
• Tedizolid (SIVEXTRO): indicated for the treatment of acute bacterial skin and skin structure infections (ABSSSI) caused by susceptible isolates of MRSA 3
• Vancomycin: 73% cure rate in microbiologically evaluable patients with MRSA skin and skin structure infection 2

From the Research

MRSA Skin Treatment Options

• MRSA skin infections can be treated with various antibiotics, including linezolid, vancomycin, and daptomycin 4, 5, 6.
• Linezolid is considered a effective treatment option for complicated MRSA skin and soft tissue infections (SSTIs) 5, 6.
• A study comparing the effectiveness of different antibiotics for MRSA SSTIs found that linezolid had a higher success rate than vancomycin (+9.7%; CrI(95%): 4.4%-15.8%) 6.
• Other treatment options for MRSA skin infections include clindamycin, doxycycline, and trimethoprim-sulfamethoxazole, although their effectiveness may vary depending on the specific strain of MRSA and the severity of the infection 7, 8.

Antibiotic Resistance and Treatment Failure

• MRSA strains can develop inducible resistance to clindamycin, which can impact treatment outcomes 7.
• Treatment failure can occur with any antibiotic, and the choice of treatment should be based on the specific characteristics of the infection and the patient 5, 8.
• The use of combination therapy or alternative antibiotics may be necessary in cases of treatment failure or antibiotic resistance 5, 7.

Current Research and Recommendations

• Current research suggests that linezolid, dalbavancin, and telavancin may be effective treatment options for MRSA SSTIs 5, 6.
• The choice of treatment should be based on the specific characteristics of the infection, the patient's medical history, and the results of antibiotic susceptibility testing 5, 8.
• Further research is needed to determine the most effective treatment strategies for MRSA skin infections and to address the growing problem of antibiotic resistance 4, 5, 8.