From the Guidelines
For patients with mash, the most appropriate medication is not explicitly stated in the provided evidence, which primarily focuses on hidradenitis suppurativa (HS) management. However, considering the context of mash might be a typographical error or confusion with a different condition, and given the information provided is about hidradenitis suppurativa, it's crucial to address the potential confusion. If we consider "mash" as potentially referring to a condition requiring antibiotic treatment similar to HS, the evidence suggests various antibiotics for different conditions. For breastfeeding patients with HS who require systemic antibiotics, options include:
- Oral metronidazole 1
- Oral rifampin 1
- Oral azithromycin 1
- Oral erythromycin 1 It's essential to note that these recommendations are for hidradenitis suppurativa, not explicitly for "mash." Given the lack of direct information on "mash" and prioritizing patient safety and the quality of life, the choice of antibiotic should be guided by the specific condition being treated, patient factors such as breastfeeding status, and local resistance patterns. In the absence of specific guidance for "mash," consulting the most recent clinical guidelines and expert opinion is recommended. The evidence provided in 1 discusses antibiotic dosages for various conditions in children, which may not directly apply to the treatment of "mash" without further clarification on the condition. Therefore, a definitive recommendation cannot be made without clearer context or information on the condition "mash" refers to.
From the Research
Medications for MRSA Infections
- Linezolid and vancomycin are commonly used antibiotics for treating skin and soft tissue infections, including those caused by methicillin-resistant Staphylococcus aureus (MRSA) 2, 3, 4, 5.
- Studies have shown that linezolid is associated with a significantly better clinical and microbiological cure rate compared to vancomycin in adults with skin and soft tissue infections, including those caused by MRSA 2, 4.
- A meta-analysis of randomized controlled trials found that linezolid was more effective than vancomycin in treating MRSA pneumonia, with higher clinical cure and microbiological eradication rates 3.
- Another study found that linezolid had a higher clinical cure rate than vancomycin in the treatment of MRSA infections, including skin and soft tissue infections 4.
- However, vancomycin is still a commonly used antibiotic for treating MRSA infections, and its effectiveness should not be overlooked 5.
Resistance to Antibiotics
- A study found that none of the Staphylococcus aureus strains isolated from pediatric patients showed resistance to linezolid, daptomycin, tigecycline, vancomycin, or tetracycline 6.
- However, the study also found that the resistance rates of S. aureus strains to penicillin, erythromycin, clindamycin, levofloxacin, and moxifloxacin were high, highlighting the need for careful selection of antibiotics in treating MRSA infections 6.
Treatment Outcomes
- Studies have shown that linezolid is associated with a shorter length of hospital stay and lower treatment costs compared to vancomycin in treating skin and soft tissue infections, including those caused by MRSA 2.
- However, linezolid is also associated with a higher risk of adverse events, such as thrombocytopenia and nausea, compared to vancomycin 2, 3.