What antibiotic covers both throat and boil infections, including MRSA (Methicillin-resistant Staphylococcus aureus)?

From the Guidelines

Clindamycin is the recommended antibiotic for treating both throat and boil infections, including those caused by MRSA, due to its effectiveness against a wide range of bacteria, including streptococci and resistant staphylococci 1. For adults, a typical dosage is 300-450 mg orally every 6-8 hours for 7-10 days, while children usually receive 8-25 mg/kg/day divided into three or four doses. Clindamycin works well against many bacteria that cause throat infections and skin infections, including MRSA. Other options for MRSA treatment include trimethoprim-sulfamethoxazole (Bactrim), doxycycline, or linezolid, though these may not cover all throat pathogens as effectively 1. It's essential to complete the full course of antibiotics even if symptoms improve quickly. Patients should be aware that clindamycin can cause gastrointestinal side effects like diarrhea, and severe diarrhea should prompt immediate medical attention as it could indicate C. difficile infection 1. Any antibiotic treatment should be prescribed by a healthcare provider after proper diagnosis, as throat and skin infections can have different causes requiring specific treatments. Some key points to consider when treating SSTIs include:

• Incision and drainage is 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.
• Empirical therapy for CA-MRSA is recommended for outpatients with purulent cellulitis, while empirical therapy for b-hemolytic streptococci is recommended for outpatients with nonpurulent cellulitis 1.
• Cultures from abscesses and other purulent SSTIs are recommended in patients treated with antibiotic therapy, patients with severe local infection or signs of systemic illness, patients who have not responded adequately to initial treatment, and if there is concern for a cluster or outbreak 1.

From the FDA Drug Label

The linezolid resistance in these organisms was associated with a point mutation in the 23S rRNA (substitution of thymine for guanine at position 2576) of the organism. Linezolid has been shown to be active against most isolates of the following microorganisms, both in vitro and in clinical infections, as described in the INDICATIONS AND USAGE section Aerobic and facultative Gram-positive microorganisms Staphylococcus aureus (including methicillin-resistant strains) Streptococcus agalactiae Streptococcus pneumoniae (including multi-drug resistant isolates [MDRSP]1) Streptococcus pyogenes

The antibiotic that covers both throat and boil infections, including MRSA, is linezolid.

• Key points:
  • Linezolid is effective against Gram-positive bacteria, including MRSA.
  • It is active against Streptococcus pyogenes, which can cause throat infections.
  • It is also active against Staphylococcus aureus, including methicillin-resistant strains, which can cause boil infections.
  • The FDA drug label for linezolid 2 supports its use for these types of infections. However, tedizolid is also an option as it has been shown to be active against most isolates of the following bacteria, both in vitro and in clinical infections,

    Aerobic bacteria Gram-positive bacteria Staphylococcus aureus (including methicillin-resistant [MRSA] and methicillin-susceptible [MSSA] isolates) Streptococcus pyogenes Streptococcus agalactiae The FDA drug label for tedizolid 3 supports its use for these types of infections.

From the Research

Antibiotic Options for Throat and Boil Infections, including MRSA

• The choice of antibiotic for treating both throat and boil infections, including those caused by MRSA, depends on various factors including the severity of the infection, patient's medical history, and local resistance patterns 4, 5, 6.
• For MRSA infections, effective drugs include vancomycin, quinupristin-dalfopristin, linezolid, tigecycline, telavancin, ceftaroline, and daptomycin 4.
• Linezolid is considered a drug of choice for complicated MRSA skin and soft tissue infections, including boils 4.
• Tedizolid, a second-generation oxazolidinone, has shown greater in vitro potency than linezolid against MRSA and can be considered a therapeutic alternative for skin and soft tissue infections 5.
• Clindamycin, trimethoprim-sulfamethoxazole, doxycycline, and minocycline are oral anti-staphylococcal agents that may be useful in treating skin and soft tissue infections, including boils, but their efficacy against MRSA can vary 4, 6, 7.
• For throat infections caused by group A streptococci, penicillin is still considered a first-line treatment, but cephalosporins may be more effective in preventing relapse 8.

Considerations for Antibiotic Choice

• The choice of antibiotic should be guided by local resistance patterns and the severity of the infection 4, 5, 6.
• It is essential to consider the potential for adverse effects and the risk-benefit ratio of antibiotic treatment 8, 7.
• In cases where MRSA is suspected or confirmed, it is crucial to choose an antibiotic with proven efficacy against this pathogen 4, 5, 6.