From the Guidelines
Linezolid is the most recommended oral antibiotic for treating MRSA infections, as suggested by the 2018 WSES/SIS-E consensus conference 1. The typical adult dose is 600 mg twice daily for 7-14 days, depending on the severity and location of the infection. Alternatives include trimethoprim-sulfamethoxazole (TMP-SMX) (one or two double-strength tablets, 160mg/800mg, twice daily), doxycycline (100mg twice daily), or tedizolid, particularly when patients have allergies or contraindications to linezolid. For mild skin infections, treatment should be combined with proper wound care, including incision and drainage of abscesses when present. MRSA has developed resistance to beta-lactam antibiotics through the acquisition of the mecA gene, which alters the penicillin-binding protein target. Therefore, these alternative antibiotics that work through different mechanisms are necessary for effective treatment. Some key points to consider when choosing an oral antibiotic for MRSA include:
- The severity and location of the infection
- The presence of any allergies or contraindications to specific antibiotics
- The need for proper wound care, including incision and drainage of abscesses
- The importance of completing the full course of antibiotics to prevent recurrence and further resistance development. It's also important to note that the use of rifampin as a single agent or as adjunctive therapy for the treatment of SSTI is not recommended 1. Additionally, clindamycin, tetracyclines, and fluoroquinolones may be effective for CA-MRSA, but their use should be guided by local epidemiology and susceptibility patterns 1. Overall, the choice of oral antibiotic for MRSA should be based on the individual patient's needs and the specific characteristics of the infection, as well as the most recent and highest-quality evidence available 1.
From the FDA Drug Label
Adult patients with infection due to MRSA should be treated with ZYVOX 600 mg q12h
- Linezolid (PO) is recommended for treating Methicillin-resistant Staphylococcus aureus (MRSA) infections.
- The recommended dosage is 600 mg orally every 12 hours.
- The cure rates in microbiologically evaluable patients with MRSA skin and skin structure infection were 79% for linezolid-treated patients 2.
- In another study, the cure rates for MRSA were 71% for linezolid-treated patients 2.
From the Research
Oral Antibiotics for MRSA Infections
The following oral antibiotics are recommended for treating Methicillin-resistant Staphylococcus aureus (MRSA) infections:
- Trimethoprim-sulfamethoxazole 3, 4
- Clindamycin 3, 5, 6
- Doxycycline 3, 5, 4
- Minocycline 5, 4, 7
- Linezolid 3, 4, 6, 7
Considerations for Choosing an Oral Antibiotic
When selecting an oral antibiotic for MRSA infections, consider the following factors:
- Site and severity of the infection 3
- Local antibiotic resistance patterns 4, 7
- Potential adverse effects 4, 6
- Cost of treatment 4
- Patient compliance 4
Specific Infections and Recommended Treatments
For uncomplicated skin and soft-tissue infections, minocycline is a preferred option 5. For more severe infections, such as pneumonia or bacteremia, linezolid or other intravenous antibiotics may be necessary 3, 7.