What is the recommended antibiotic regimen for a hospital patient with cellulitis and a history of Methicillin-resistant Staphylococcus aureus (MRSA)?

From the Guidelines

For a hospital patient with cellulitis and a history of MRSA, the recommended antibiotic regimen is intravenous vancomycin, typically dosed at 15-20 mg/kg every 8-12 hours (not to exceed 2g per dose), with adjustments based on renal function and therapeutic drug monitoring. This recommendation is based on the most recent and highest quality study available, which prioritizes vancomycin as the primary treatment option for MRSA infections in hospitalized patients 1.

Key Considerations

• The patient's history of MRSA necessitates the use of an antibiotic effective against this resistant strain.
• Vancomycin is the preferred choice due to its effectiveness against MRSA, as evidenced by its recommendation in the 2014 practice guidelines for the diagnosis and management of skin and soft tissue infections 1.
• Alternative options, such as daptomycin, linezolid, or ceftaroline, may be considered based on patient-specific factors and culture results.
• Treatment duration is typically 7-14 days, depending on clinical response, and should be tailored based on culture results if available.

Adjunctive Measures

• Monitoring for treatment response should occur within 48-72 hours, with consideration for drainage of any purulent collections.
• Pain management and elevation of the affected area are important adjunctive measures during treatment.
• The use of rifampin as a single agent or as adjunctive therapy for the treatment of SSTI is not recommended, as stated in the clinical practice guidelines by the Infectious Diseases Society of America 1.

Evidence-Based Practice

The recommendation for vancomycin is supported by the 2014 practice guidelines, which provide a comprehensive update on the diagnosis and management of skin and soft tissue infections 1. This guideline prioritizes vancomycin as the primary treatment option for MRSA infections in hospitalized patients, highlighting its effectiveness and importance in clinical practice.

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

• Recommended antibiotic regimen: Linezolid or Vancomycin can be considered for the treatment of cellulitis with a history of MRSA in a hospital patient.
• Key points:
  • Linezolid has a cure rate of 79% in microbiologically evaluable patients with MRSA skin and skin structure infection.
  • Vancomycin has a cure rate of 73% in microbiologically evaluable patients with MRSA skin and skin structure infection. 2

From the Research

Antibiotic Regimens for Hospital Patients with Cellulitis and MRSA History

• The recommended antibiotic regimen for a hospital patient with cellulitis and a history of Methicillin-resistant Staphylococcus aureus (MRSA) includes vancomycin, linezolid, daptomycin, or a combination of these drugs 3, 4, 5, 6.
• Vancomycin remains a first-line treatment for MRSA infections, but resistance to this drug is a growing concern 3, 5.
• Linezolid has shown efficacy and safety in treating MRSA-caused complicated skin and soft-tissue infections (cSSTI) and may be a potential first-line drug against MRSA bacteremia 4, 5, 6.
• Daptomycin is an effective treatment option for cSSTI with MRSA bacteremia and can be used in combination with linezolid for severe cases 3, 4.
• The choice of antibiotic regimen should be individualized based on the patient's specific needs and the severity of the infection 4, 7.

Key Considerations

• The presence of MRSA colonization or infection can significantly impact the choice of antibiotic regimen 4, 7.
• The development of new antibiotics is urgent to address the growing concern of antibiotic resistance 4, 6.
• Clinical and microbiological cure rates, as well as safety profiles, should be considered when selecting an antibiotic regimen 5, 6.

Available Antibiotic Options

• Vancomycin: a first-line treatment for MRSA infections, but resistance is a growing concern 3, 5.
• Linezolid: effective and safe for treating MRSA-caused cSSTI and may be a potential first-line drug against MRSA bacteremia 4, 5, 6.
• Daptomycin: an effective treatment option for cSSTI with MRSA bacteremia and can be used in combination with linezolid for severe cases 3, 4.
• Tedizolid: may be an alternative option for treating MRSA-caused SSTIs, but more research is needed to confirm its efficacy and safety 6.