What is the recommended treatment for a 5-year-old with Methicillin-resistant Staphylococcus aureus (MRSA) of the skin?

From the Guidelines

For a 5-year-old with MRSA skin infection, the recommended treatment typically includes oral antibiotics such as clindamycin at a dose of 10-13 mg/kg/dose PO every 6-8 hours, not to exceed 40 mg/kg/day, or trimethoprim-sulfamethoxazole (TMP-SMX) at a dose of 8-12 mg/kg/day of the trimethoprim component divided twice daily for 7-10 days.

Treatment Approach

The approach to treating MRSA skin infections in children involves assessing the severity of the infection and the presence of any complicating factors.

• For mild cases with small abscesses, incision and drainage alone may be sufficient 1.
• Any abscess should be drained if fluctuant, regardless of antibiotic therapy.
• Topical measures include keeping the area clean with regular soap and water washing, covering draining wounds with clean bandages, and applying mupirocin ointment to localized lesions twice daily for 5-7 days.

Antibiotic Therapy

Weight-based dosing is crucial for children to ensure adequate treatment while avoiding toxicity.

• Clindamycin is effective in children with CA-MRSA SSTI 1.
• TMP-SMX is another option, but its use should be guided by local resistance patterns and the specific clinical scenario.

Prevention of Spread

Good hygiene practices should be emphasized to prevent spread within households, including not sharing personal items like towels and regular handwashing.

• If the infection worsens despite treatment or if the child develops fever or appears systemically ill, immediate medical reassessment is necessary.

Considerations

MRSA is resistant to beta-lactam antibiotics including methicillin, oxacillin, and all penicillins and cephalosporins, which is why these alternative antibiotics are necessary 1.

• The choice of antibiotic should be based on the severity of the infection, the presence of any complicating factors, and the results of culture and susceptibility testing, if available.

From the Research

Treatment Options for MRSA Skin Infections in Children

• The recommended treatment for a 5-year-old with Methicillin-resistant Staphylococcus aureus (MRSA) of the skin includes clindamycin or trimethoprim-sulfamethoxazole (TMP-SMX) for uncomplicated skin infections 2, 3, 4, 5.
• Clindamycin is often preferred due to its effectiveness against MRSA and its ability to penetrate into abscesses 3, 6, 5.
• TMP-SMX is also an option, but its efficacy has been questioned in some studies 3, 4, 5.
• Minocycline is another alternative that has shown promise in treating uncomplicated skin and soft-tissue infections caused by MRSA 6.
• Vancomycin remains the treatment of choice for severe MRSA infections 2.

Considerations for Treatment

• The choice of antibiotic should be based on the severity of the infection, the presence of any underlying medical conditions, and the potential for adverse effects 2, 4.
• Incision and drainage of abscesses is often necessary in addition to antibiotic therapy 3, 5.
• Supportive management, including wound cleaning and removal of any infected foreign bodies, is also crucial for ensuring cure 2.

Efficacy of Treatment Options

• Studies have shown that clindamycin and TMP-SMX have similar cure rates for uncomplicated skin infections, but clindamycin may have a lower rate of recurrence 3, 5.
• Minocycline has been shown to be effective in treating uncomplicated skin and soft-tissue infections caused by MRSA, especially when other antibiotics have failed 6.
• Vancomycin is effective against severe MRSA infections, but its use is typically reserved for more serious cases due to its potential for adverse effects 2.