What is the recommended treatment for a Methicillin-resistant Staphylococcus aureus (MRSA) infection of the nose, sensitive to Ceftin (cefuroxime), resulting from a traumatic injury?

Treatment for MRSA Infection in the Nose Following Traumatic Injury

For a MRSA infection in the nose that is sensitive to cefuroxime (Ceftin), oral cefuroxime axetil 250-500 mg twice daily for 7-10 days is the recommended treatment. 1

Treatment Algorithm

Initial Management:

1. Incision and drainage of any purulent collection if present 2
2. Culture and sensitivity testing (already done in this case, showing MRSA sensitive to cefuroxime)
3. Antibiotic therapy based on sensitivity results

Antibiotic Selection:

• Primary choice: Cefuroxime axetil (Ceftin) 250-500 mg orally twice daily for 7-10 days 1
• This is appropriate since the organism is specifically reported as sensitive to this agent

Alternative Options (if cefuroxime cannot be used):

• Trimethoprim-sulfamethoxazole: 1-2 double-strength tablets twice daily 2
• Doxycycline: 100 mg twice daily (if patient is ≥8 years old) 2
• Clindamycin: 300-450 mg orally three times daily (if susceptible) 2

Special Considerations

Nasal Decolonization:

• Consider adding intranasal mupirocin twice daily for 5-7 days to help eradicate nasal colonization 2
• This is particularly important for nasal infections to prevent recurrence

Additional Measures:

• Daily chlorhexidine washes
• Daily decontamination of personal items such as towels, sheets, and clothes 2

Monitoring and Follow-up

• Assess clinical response within 48-72 hours of starting treatment
• Complete the full course of antibiotics even if symptoms improve quickly
• If no improvement after 72 hours, reassess and consider alternative antibiotics or additional drainage

Important Caveats

1. Duration of therapy: While the IDSA guidelines recommend a minimum 5-day course for most skin and soft tissue infections, treatment should be extended if the infection has not improved within this time period 2. For MRSA infections, particularly in anatomically complex areas like the nose, a 7-10 day course is typically recommended.

2. Potential pitfall: Cephalosporins (including cefuroxime) are traditionally not considered first-line agents for MRSA infections. The fact that this particular strain is sensitive to cefuroxime is somewhat unusual, as most MRSA strains are resistant to beta-lactam antibiotics. This sensitivity should be confirmed if possible.

3. Bioavailability consideration: Cefuroxime axetil has good tissue penetration and twice-daily dosing makes it convenient for outpatient treatment 1.

4. Recurrence prevention: For patients with recurrent MRSA infections, a 5-day decolonization regimen with intranasal mupirocin, daily chlorhexidine washes, and decontamination of personal items should be considered 2.