Oral Vancomycin Is Not Indicated for MRSA Abscess Treatment
Oral vancomycin is not recommended for treating MRSA abscesses as it has poor systemic absorption and is only indicated for Clostridioides difficile infections. 1 Instead, incision and drainage plus appropriate systemic antibiotics should be used.
Primary Management of MRSA Abscesses
- Incision and drainage is the primary treatment for uncomplicated abscesses and may be sufficient alone for small, uncomplicated abscesses 2
- Antibiotic therapy is recommended for abscesses with:
- Severe or extensive disease (multiple sites)
- Rapid progression with associated cellulitis
- Signs of systemic illness
- Immunosuppression or comorbidities
- Extremes of age
- Difficult-to-drain locations (face, hand, genitalia)
- Associated septic phlebitis
- Lack of response to drainage alone 2
Recommended Oral Antibiotics for MRSA Abscesses
For outpatient treatment of MRSA abscesses requiring antibiotics, the following oral options are recommended:
- Clindamycin 300-450 mg PO four times daily (A-II) 2
- Trimethoprim-sulfamethoxazole (TMP-SMX) 1-2 double-strength tablets twice daily (A-II) 2
- Doxycycline or minocycline 100 mg PO twice daily (A-II) 2
- Linezolid 600 mg PO twice daily (A-II) 2
For Hospitalized Patients with Complicated MRSA Infections
- IV vancomycin 15-20 mg/kg/dose every 8-12 hours (not to exceed 2g per dose) (A-I) 2
- Daptomycin 4 mg/kg/dose IV once daily (A-I) 2
- Linezolid 600 mg PO/IV twice daily (A-I) 2
- Telavancin 10 mg/kg/dose IV once daily (A-I) 2
- Clindamycin 600 mg IV or PO three times daily (A-III) 2
Important Considerations for Vancomycin Use
- Oral vancomycin is specifically indicated for C. difficile infections and staphylococcal enterocolitis at doses of 500 mg to 2 g daily in 3-4 divided doses for 7-10 days 1
- Oral vancomycin is not absorbed systemically and therefore ineffective for treating MRSA abscesses 1
- For systemic MRSA infections requiring vancomycin, the IV route must be used 1
- For serious MRSA infections, vancomycin trough concentrations of 15-20 μg/mL are recommended 2
Duration of Therapy
- For skin and soft tissue infections, 5-10 days of therapy is typically recommended, but should be individualized based on clinical response 2
- For complicated infections, 7-14 days is generally recommended 2
Pediatric Considerations
- In children, clindamycin 10-13 mg/kg/dose IV every 6-8 hours (not to exceed 40 mg/kg/day) is an option if local clindamycin resistance is low (<10%) 2
- Linezolid 10 mg/kg/dose PO/IV every 8 hours (not to exceed 600 mg/dose) for children <12 years of age 2
- Tetracyclines should not be used in children <8 years of age 2
Prevention of Recurrent MRSA Infections
- Keep draining wounds covered with clean, dry bandages 2
- Maintain good personal hygiene with regular bathing 2
- Clean hands regularly with soap and water or alcohol-based hand sanitizer 2
- Focus cleaning on high-touch surfaces that contact bare skin 2
Remember that cultures from abscesses should be obtained in patients receiving antibiotic therapy, those with severe local infection or systemic illness, those not responding to initial treatment, or when there is concern for an outbreak 2.