What is the recommended treatment for a Staphylococcus aureus (Staph) wound?

From the Guidelines

The recommended treatment for a Staphylococcus aureus wound typically involves cleaning the wound with soap and water, applying topical antibiotics like mupirocin (Bactroban) 2% ointment three times daily for 7-10 days, and covering with a clean bandage changed daily. For mild infections, oral antibiotics such as cephalexin (500 mg four times daily), dicloxacillin (500 mg four times daily), or clindamycin (300-450 mg three times daily) for 7-10 days may be prescribed 1. Severe infections might require intravenous antibiotics like vancomycin, particularly for MRSA (methicillin-resistant Staphylococcus aureus) 1. It's essential to complete the full course of antibiotics even if symptoms improve quickly. Warm compresses applied to the area for 15 minutes several times daily can help improve blood flow and healing. Patients should monitor for spreading redness, increased pain, fever, or pus drainage, which indicate worsening infection requiring immediate medical attention. Staph bacteria are common skin colonizers that can cause infection when they enter breaks in the skin, and proper treatment is essential to prevent complications like cellulitis, abscesses, or systemic infection. Incision and drainage is the primary treatment for cutaneous abscesses, and antibiotic therapy may be recommended for abscesses associated with severe or extensive disease, signs and symptoms of systemic illness, or lack of response to incision and drainage alone 1. Empirical therapy for CA-MRSA is recommended for outpatients with purulent cellulitis, and options include clindamycin, TMP-SMX, a tetracycline, or linezolid 1. For hospitalized patients with complicated SSTI, empirical therapy for MRSA should be considered pending culture data, and options include IV vancomycin, linezolid, daptomycin, telavancin, or clindamycin 1.

Some key points to consider in the treatment of Staphylococcus aureus wounds include:

• Cleaning and dressing the wound properly to promote healing and prevent infection
• Using topical antibiotics like mupirocin for mild infections
• Prescribing oral antibiotics like cephalexin, dicloxacillin, or clindamycin for mild to moderate infections
• Using intravenous antibiotics like vancomycin for severe infections or MRSA
• Monitoring for signs of worsening infection and seeking medical attention if necessary
• Considering empirical therapy for CA-MRSA in outpatients with purulent cellulitis
• Considering empirical therapy for MRSA in hospitalized patients with complicated SSTI pending culture data.

It's also important to note that the treatment of Staphylococcus aureus wounds may vary depending on the severity of the infection, the presence of underlying medical conditions, and the patient's overall health status. Therefore, it's essential to consult with a healthcare professional for proper diagnosis and treatment. In general, the goal of treatment is to promote healing, prevent complications, and improve patient outcomes. By following proper treatment guidelines and seeking medical attention when necessary, patients with Staphylococcus aureus wounds can reduce their risk of complications and improve their chances of a successful recovery.

From the FDA Drug Label

5.9 Persisting or Relapsing S. aureus Bacteremia/Endocarditis Patients with persisting or relapsing S. aureus bacteremia/endocarditis or poor clinical response should have repeat blood cultures. If a blood culture is positive for S aureus, minimum inhibitory concentration (MIC) susceptibility testing of the isolate should be performed using a standardized procedure, and diagnostic evaluation of the patient should be performed to rule out sequestered foci of infection. Appropriate surgical intervention (e.g., debridement, removal of prosthetic devices, valve replacement surgery) and/or consideration of a change in antibacterial regimen may be required.

The recommended treatment for a Staphylococcus aureus (Staph) wound is not explicitly stated in the provided drug label. However, for S. aureus bacteremia/endocarditis, the label suggests that patients with persisting or relapsing infection should undergo repeat blood cultures, MIC susceptibility testing, and diagnostic evaluation to rule out sequestered foci of infection. Appropriate surgical intervention (e.g., debridement) and/or consideration of a change in antibacterial regimen may be required 2.

From the Research

Treatment Options for Staphylococcus aureus Wounds

The treatment for Staphylococcus aureus (Staph) wounds depends on the severity of the infection and the type of bacteria present.

• For methicillin-susceptible S. aureus (MSSA) infections, penicillinase-resistant penicillins such as flucloxacillin are the antibiotics of choice 3.
• For less serious MSSA infections, first-generation cephalosporins, clindamycin, lincomycin, and erythromycin can be used 3.
• For methicillin-resistant S. aureus (MRSA) infections, parenteral vancomycin or teicoplanin are recommended 3.
• For community-acquired MRSA infections, lincosamides such as clindamycin or cotrimoxazole can be used 3.
• Minocycline is also effective in treating uncomplicated community-acquired MRSA skin and soft-tissue infections 4.

Antibiotic Resistance and Treatment

Staphylococcus aureus has developed resistance to many antibiotics, making treatment challenging.

• Only about 20% of S. aureus strains are sensitive to penicillin 5.
• MRSA strains are resistant to all beta-lactam antibiotics 5.
• Glycopeptide antibiotics such as vancomycin are effective against most MRSA strains, but some strains have reduced susceptibility or resistance to these antibiotics 5.
• New antibiotics such as linezolid, daptomycin, and quinupristin/dalfopristin have been developed to treat MRSA infections 6.

Treatment Considerations in Children

In children, the treatment of staphylococcal skin infections depends on the severity of the infection and the health of the child.

• Penicillinase-resistant penicillins such as flucloxacillin are the treatment of choice for oral antibacterials 7.
• Cefalexin and erythromycin are suitable alternatives, but care must be taken to avoid developing resistance to multiple families of antibacterials 7.
• For severe infections, vancomycin remains the treatment of choice, while intravenous teicoplanin and clindamycin are suitable alternatives 7.