Treatment Duration for MRSA Wound Infections with Clindamycin
For MRSA wound infections, treatment with clindamycin should be administered for 7-14 days, with the duration individualized based on the patient's clinical response. 1
Treatment Approach Based on Wound Complexity
Uncomplicated MRSA Wound Infections
- For outpatient treatment of uncomplicated MRSA skin and soft tissue infections (SSTIs), clindamycin 600 mg orally three times daily is an effective option 1
- Treatment duration should be 5-10 days for uncomplicated infections, adjusted based on clinical response 1
- Clindamycin provides coverage for both MRSA and beta-hemolytic streptococci, making it suitable as monotherapy 1
Complicated MRSA Wound Infections
- For complicated SSTIs (deeper soft-tissue infections, surgical/traumatic wound infections, major abscesses, infected ulcers and burns), clindamycin 600 mg IV/PO three times daily is recommended 1
- Treatment duration should be 7-14 days for complicated infections, with adjustments based on clinical response 1
- Surgical debridement is essential alongside antibiotic therapy for abscesses and complicated infections 1
Special Considerations
Pediatric Patients
- For hospitalized children with complicated MRSA SSTIs, clindamycin 10-13 mg/kg/dose IV every 6-8 hours (to administer 40 mg/kg/day) is recommended if local resistance rates are low (<10%) 1
- Transition to oral therapy can be made if the strain is susceptible 1
- Tetracyclines should not be used in children under 8 years of age 1
Inducible Clindamycin Resistance
- D-test should be performed before initiating clindamycin therapy to detect inducible clindamycin resistance, which can lead to treatment failure 2, 3
- In areas with high rates of inducible clindamycin resistance, alternative agents like trimethoprim-sulfamethoxazole or linezolid may be preferred 3
Alternative Treatment Options
- If clindamycin cannot be used, alternatives include:
Monitoring and Follow-up
- Clinical reassessment within 48-72 hours is essential to ensure appropriate response to therapy 6
- Cultures from abscesses and purulent SSTIs are recommended in patients treated with antibiotics to confirm the causative organism and guide therapy 1
- If no improvement occurs within 72 hours, consider culture and sensitivity testing if not already done, and possible modification of antibiotic therapy 6
Prevention of Recurrence
- Keep draining wounds covered with clean, dry bandages 1
- Maintain good personal hygiene with regular bathing and handwashing 1
- Avoid reusing or sharing personal items that have contacted infected skin 1
- Focus cleaning efforts on high-touch surfaces using appropriate cleaners 1
- Consider decolonization strategies for patients with recurrent MRSA infections 1