From the Guidelines
Outpatient treatment for MRSA typically involves oral antibiotics, with trimethoprim-sulfamethoxazole (TMP-SMX) being the first-line option at a dose of 1-2 double-strength tablets (160mg/800mg) twice daily for 7-14 days, as recommended by the Infectious Diseases Society of America 1.
Treatment Options
The following oral antibiotics are recommended for empirical coverage of CA-MRSA in outpatients with skin and soft-tissue infections (SSTIs):
- Clindamycin (300-450mg three times daily) 1
- Trimethoprim-sulfamethoxazole (TMP-SMX) (1-2 double-strength tablets, 160mg/800mg, twice daily) 1
- Doxycycline (100mg twice daily) 1
- Linezolid (600mg twice daily) 1
Incision and Drainage
Incision and drainage is the primary treatment for cutaneous abscesses, and may be sufficient without antibiotics in some cases, especially for simple abscesses or boils 1.
Patient Care
Patients should keep wounds clean and covered, change dressings regularly, and practice good hygiene including hand washing and not sharing personal items 1.
Decolonization
Decolonization may be recommended for recurrent infections using intranasal mupirocin ointment applied twice daily for 5 days, along with chlorhexidine body washes 1.
Duration of Therapy
The duration of therapy should be individualized based on the patient's clinical response, but typically ranges from 5-14 days 1.
Key Considerations
- Patients should complete the full course of antibiotics even if symptoms improve 1.
- Patients should seek medical attention if the infection worsens or doesn't improve within 48-72 hours 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 Table 18 Cure Rates at the Test-of-Cure Visit for Microbiologically Evaluable Adult Patients with Complicated Skin and Skin Structure Infections Pathogen Cured ZYVOXn/N (%) Oxacillin/Dicloxacillinn/N (%) Methicillin-resistant S aureus 2/3 (67) 0/0 (-) Table 19 Cure Rates at the Test-of-Cure Visit for Microbiologically Evaluable Adult Patients with Diabetic Foot Infections Pathogen Cured ZYVOXn/N (%) Comparatorn/N (%) Methicillin-resistant S aureus 12/17 (71) 2/3 (67)
Treatment options for MRSA in an outpatient setting include:
- Linezolid: with a cure rate of 79% in microbiologically evaluable patients with MRSA skin and skin structure infection 2
- Vancomycin: with a cure rate of 73% in microbiologically evaluable patients with MRSA skin and skin structure infection 2 Key points:
- Linezolid and vancomycin are effective treatment options for MRSA infections
- The choice of treatment should be based on the specific clinical situation and patient factors 2
From the Research
Treatment Options for MRSA in Outpatient Setting
- Oral antibiotics are a viable option for treating uncomplicated skin and soft tissue infections caused by MRSA in an outpatient setting 3, 4, 5, 6, 7
- The choice of antibiotic should be based on the severity and site of the infection, as well as local susceptibility patterns 3, 6
- Common oral antibiotics used to treat MRSA infections in outpatient settings include:
Considerations for Antibiotic Choice
- The efficacy of various antibiotic regimens can vary depending on the specific strain of MRSA and the severity of the infection 3, 4, 6
- Incision and drainage of abscesses is often necessary in addition to antibiotic therapy 4, 7
- Monitoring response to treatment and adjusting the antibiotic regimen as needed is crucial to ensure effective treatment and prevent excessive antibiotic use 7
Alternative Therapies
- Vancomycin is often used as a standard empiric choice for severe or invasive MRSA infections, but alternative therapies such as ceftaroline, ceftobribole, dalbavancin, oritavancin, and tedizolid may be considered in certain cases 3
- Daptomycin and tigecycline are also effective against MRSA, but are typically reserved for severe infections and are only available in intravenous form 7