From the Guidelines
MRSA skin infections are typically treated with a combination of antibiotics and wound care, with oral antibiotics like trimethoprim-sulfamethoxazole, clindamycin, or doxycycline commonly prescribed for mild infections, and intravenous antibiotics such as vancomycin, daptomycin, or linezolid necessary for more severe infections. The treatment approach should prioritize the patient's clinical response and the severity of the infection. According to the most recent guidelines 1, for oral antibiotic coverage of MRSA in patients with skin and soft-tissue infections (SSTIs), linezolid, trimethoprim-sulfamethoxazole, a tetracycline (doxycycline or minocycline), or tedizolid are recommended. For intravenous antibiotic coverage, daptomycin, IV linezolid, IV ceftaroline, IV dalbavancin, IV vancomycin, IV tigecycline, or IV tedizolid are suggested.
Proper wound care is essential and includes:
- Incision and drainage of abscesses
- Keeping the area clean with gentle soap and water
- Covering with sterile bandages
- Changing dressings regularly
It's crucial to complete the full course of antibiotics even if symptoms improve quickly to prevent recurrence and antibiotic resistance. MRSA is resistant to many common antibiotics, which is why specific medications are needed to effectively treat these infections. If a suspected MRSA infection is present, seeking medical attention promptly for proper diagnosis through wound culture is important for determining the most effective treatment. The duration of antibiotic therapy should be individualized based on the patient's clinical response, with a typical course ranging from 7 to 14 days 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
- Treatment for MRSA skin infections:
- Linezolid is effective, with a cure rate of 79% in microbiologically evaluable patients.
- Vancomycin is also effective, with a cure rate of 73% in microbiologically evaluable patients. 2
From the Research
Treatment Options for MRSA Skin Infections
The treatment for Methicillin-resistant Staphylococcus aureus (MRSA) skin infections can be categorized into topical and systemic treatments.
- Topical treatments include:
- Retapamulin, which has been shown to reduce bacterial loads by 2.5 log(10) CFU after 3 days of treatment and 5.0 log(10) CFU after 6 days of treatment 3
- Mupirocin, which has been shown to reduce bacterial loads by 2.0 log(10) CFU after 3 days of treatment and 5.1 log(10) CFU after 6 days of treatment 3
- Fusidic acid, which has been shown to reduce bacterial loads by 2.9 log(10) CFU after 3 days of treatment and 4.2 log(10) CFU after 6 days of treatment 3
- Systemic treatments include:
- Linezolid, which has been shown to reduce bacterial loads by 1.6 log(10) CFU after 6 days of treatment 3
- Vancomycin, which has been shown to be effective in treating MRSA infections, but its use is often limited by concerns about resistance 4, 5, 6
- Daptomycin, which has been shown to be effective in treating MRSA bacteremia and may be considered as an alternative to vancomycin 4, 5
Considerations for Treatment
When choosing a treatment for MRSA skin infections, it is essential to consider the severity of the infection, the patient's medical history, and the potential for resistance to certain antibiotics.
- The use of topical antibiotics such as mupirocin and retapamulin may be effective for uncomplicated skin infections, but systemic antibiotics such as linezolid and vancomycin may be necessary for more severe infections 3, 4, 5, 6
- The development of resistance to certain antibiotics is a concern, and combination therapy or alternative treatments such as daptomycin may be necessary in some cases 4, 6
- The in vitro activity of retapamulin and other antimicrobial agents against MRSA isolates has been studied, and retapamulin has been shown to have a low rate of resistance 7