From the Guidelines
For the treatment of Methicillin-resistant Staphylococcus aureus (MRSA) infections, vancomycin is the first-line treatment, usually administered intravenously at 15-20 mg/kg every 8-12 hours for 7-14 days, depending on infection severity and site. This recommendation is based on the most recent and highest quality study available, which emphasizes the importance of effective antibiotic therapy in managing MRSA infections 1.
Key Considerations for MRSA Treatment
- The choice of antibiotic should be guided by the severity of the infection, the presence of any underlying health conditions, and the susceptibility of the MRSA isolate to various antibiotics.
- For less severe skin infections, oral options like linezolid, clindamycin, or trimethoprim-sulfamethoxazole may be sufficient, as suggested by studies 1.
- Treatment duration typically ranges from 7-14 days but may extend longer for complicated infections like osteomyelitis or endocarditis.
- Complete treatment courses are essential to prevent recurrence and further resistance development.
Mechanisms of Action
- Vancomycin and daptomycin disrupt cell wall synthesis.
- Linezolid inhibits protein synthesis.
- Trimethoprim-sulfamethoxazole interferes with folate metabolism.
Additional Recommendations
- For empirical coverage of CA-MRSA in outpatients with skin and soft-tissue infections (SSTIs), oral antibiotic options include linezolid, trimethoprim-sulfamethoxazole, a tetracycline (doxycycline or minocycline), and tedizolid, as recommended by recent guidelines 1.
- Intravenous antibiotic options for MRSA SSTIs include daptomycin, IV linezolid, IV ceftaroline, IV dalbavancin, IV vancomycin, IV tigecycline, and IV tedizolid.
- Drainage of abscesses is often necessary alongside antibiotic therapy for optimal outcomes, especially in cases of severe or extensive disease, or when there are signs of systemic illness 1.
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 The cure rates by pathogen for microbiologically evaluable patients are presented in Table 18. Methicillin-resistant S aureus 2/3 (67) The cure rates by pathogen for microbiologically evaluable patients are presented in Table 19. Methicillin-resistant S aureus 12/17 (71)
Antibiotics for MRSA treatment:
- Linezolid
- Vancomycin
- Daptomycin
The cure rates for MRSA infections were 79% for linezolid-treated patients and 73% for vancomycin-treated patients, and 71% for linezolid-treated patients in another study. Daptomycin also showed success rates in treating MRSA infections. 2 3
From the Research
Antibiotics for MRSA Treatment
The following antibiotics are used to treat Methicillin-resistant Staphylococcus aureus (MRSA) infections:
- Vancomycin: considered the gold-standard treatment option for MRSA infections 4, 5, 6, 7
- Linezolid: shown to be effective in treating MRSA infections, especially in hospital-acquired pneumonia (HAP) 4, 5, 6, 7, 8
- Daptomycin: effective in treating MRSA bacteremia and complicated skin and soft-tissue infections (cSSTIs) 4, 5, 6, 7, 8
- Tigecycline: an alternative option for treating polymicrobial infections, except in diabetic foot infections 5, 6, 7, 8
- Telavancin: a derivative of vancomycin with similar clinical efficacy, but not recommended for patients with renal insufficiency 6, 7
- Ceftaroline: a β-lactam antibiotic with activity against MRSA, but limited clinical data available 6, 7
- Quinupristin/dalfopristin: effective in treating MRSA infections, but potential toxicities must be considered 7
Community-Associated MRSA (CA-MRSA) Treatment
For CA-MRSA infections, the following antibiotics may be effective:
- Ciprofloxacin
- Clindamycin
- Gentamicin
- Trimethoprim/sulfamethoxazole 4
Hospital-Acquired MRSA (HA-MRSA) Treatment
For HA-MRSA infections, the following antibiotics may be effective: