What oral antibiotics cover Staphylococcus aureus?

From the Guidelines

Oral antibiotics that cover Staphylococcus aureus include clindamycin, trimethoprim-sulfamethoxazole, doxycycline, and linezolid, with the choice of antibiotic depending on the severity of infection, local resistance patterns, and patient factors such as allergies. When considering treatment for Staphylococcus aureus infections, it is essential to note that the Infectious Diseases Society of America recommends incision and drainage as the primary treatment for cutaneous abscesses, with antibiotic therapy recommended for abscesses associated with severe or extensive disease, systemic illness, or lack of response to incision and drainage alone 1. For empirical coverage of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) in outpatients with skin and soft tissue infections (SSTIs), oral antibiotic options include:

• Clindamycin (300-450 mg orally three times daily for 7-10 days) 1
• Trimethoprim-sulfamethoxazole (1-2 double-strength tablets twice daily for 7-10 days) 1
• Doxycycline (100 mg orally twice daily for 7-10 days) 1
• Linezolid (600 mg orally twice daily for 7-10 days) 1 It is crucial to obtain cultures before starting antibiotics if possible and to complete the full course of antibiotics to prevent resistance development 1. The most recent and highest quality study, published in 2017, supports the use of these antibiotics for the treatment of Staphylococcus aureus infections, including MRSA 1. In addition to these antibiotics, other options such as cephalexin and dicloxacillin may be considered for the treatment of methicillin-susceptible Staphylococcus aureus infections 1. However, the choice of antibiotic should be guided by local resistance patterns and patient factors such as allergies. It is also essential to note that the use of rifampin as a single agent or as adjunctive therapy for the treatment of SSTIs is not recommended due to the risk of resistance development 1. In summary, the treatment of Staphylococcus aureus infections, including MRSA, requires careful consideration of the severity of infection, local resistance patterns, and patient factors, with a focus on completing the full course of antibiotics to prevent resistance development.

From the FDA Drug Label

The cure rates by pathogen for microbiologically evaluable patients are presented in Table 16. Table 16 Cure Rates at the Test-of-Cure Visit for Microbiologically Evaluable Adult Patients with Nosocomial Pneumonia Pathogen Cured ZYVOX n/N (%) Vancomycin n/N (%) Staphylococcus aureus 23/38 (61) 14/23 (61) Methicillin-resistant S. aureus 13/22 (59) 7/10 (70)

The cure rates by pathogen for microbiologically evaluable patients are presented in Table 18. Table 18 Cure Rates at the Test-of-Cure Visit for Microbiologically Evaluable Adult Patients with Complicated Skin and Skin Structure Infections Pathogen Cured ZYVOX n/N (%) Oxacillin/Dicloxacillin n/N (%) Staphylococcus aureus 73/83 (88) 72/84 (86) Methicillin-resistant S aureus 2/3 (67) 0/0 (-)

The oral antibiotic that covers Staphylococcus aureus is linezolid (ZYVOX), with cure rates of:

• 61% for Staphylococcus aureus in nosocomial pneumonia patients 2
• 88% for Staphylococcus aureus in complicated skin and skin structure infection patients 2
• 59% for Methicillin-resistant S. aureus in nosocomial pneumonia patients 2
• 67% for Methicillin-resistant S aureus in complicated skin and skin structure infection patients 2
• 79% for Methicillin-resistant Staphylococcus aureus (MRSA) skin and skin structure infection patients 2

From the Research

Oral Antibiotics for Staphylococcus aureus

• For methicillin-susceptible Staphylococcus aureus (MSSA) infections, penicillinase-resistant penicillins (flucloxacillin, dicloxacillin) are the antibiotics of choice, but first generation cephalosporins (cefazolin, cephalothin and cephalexin), clindamycin, lincomycin and erythromycin can also be used for less serious infections such as skin and soft tissue infections or in patients with penicillin hypersensitivity 3.
• Cephalexin is used for the treatment of MSSA infections in children, and twice-daily (BID) and thrice-daily (TID) cephalexin dosing regimens have been proposed to improve treatment acceptability and adherence 4.
• For methicillin-resistant Staphylococcus aureus (MRSA) infections, oral antibiotics such as linezolid, TMP-SMX, and the tetracyclines (e.g. doxycycline and minocycline) can be used for less severe infections such as skin and soft tissue infections, but their efficacy has not been well studied 5.
• Clindamycin, trimethoprim-sulfamethoxazole, doxycycline, rifampin, moxifloxacin, and minocycline are oral anti-staphylococcal agents that may have utility in the treatment of skin and soft tissue infections and osteomyelitis, but the clinical data for their efficacy is limited 6.

Specific Oral Antibiotics

• Linezolid is probably the drug of choice for the treatment of complicated MRSA skin and soft tissue infections 6.
• Clindamycin and trimethoprim-sulfamethoxazole may be used for the treatment of less severe MRSA infections such as skin and soft tissue infections 3, 5.
• Doxycycline and minocycline are oral antibiotics that have been shown to be effective against MRSA infections, but their use is limited by resistance and adverse effects 5, 6.
• Rifampin and fusidic acid can be used in combination for the treatment of multiresistant MRSA infections, but resistance develops rapidly if they are used as single agents 3.