Does Biaxin Cover MRSA?
No, Biaxin (clarithromycin) does not provide reliable coverage for MRSA and should not be used as monotherapy for MRSA infections.
Why Clarithromycin Is Not Recommended for MRSA
Clarithromycin is a macrolide antibiotic that is not included in any guideline recommendations for MRSA treatment. The IDSA guidelines for MRSA infections do not list clarithromycin among the recommended oral or intravenous options for MRSA skin and soft tissue infections 1.
- Macrolides like erythromycin (in the same class as clarithromycin) have high resistance rates among MRSA strains and are not considered effective treatment options 2, 3.
- While one experimental study showed potential synergy when clarithromycin was combined with daptomycin in liposomal formulations at a 32:1 ratio, this was only in a research setting and clarithromycin alone showed no anti-MRSA activity 4.
Recommended Oral Antibiotics for MRSA
For outpatient MRSA skin and soft tissue infections, the IDSA recommends the following oral options:
- Trimethoprim-sulfamethoxazole (TMP-SMX) - First-line choice with excellent MRSA coverage 1, 5
- Clindamycin (300-450 mg three times daily) - Effective but requires checking for inducible resistance via D-zone testing 1, 6
- Tetracyclines (doxycycline 100 mg twice daily or minocycline 100 mg twice daily) - Good alternative with high susceptibility rates 1, 3
- Linezolid (600 mg twice daily) - Highly effective but expensive 1, 3
Important Clinical Caveat
Clindamycin resistance can emerge during therapy in erythromycin-resistant MRSA strains due to linked resistance mechanisms (inducible clindamycin resistance). One pediatric case demonstrated development of clindamycin resistance during treatment of an initially susceptible MRSA strain 7. Therefore, D-zone testing should be performed when considering clindamycin for serious MRSA infections 6.
Intravenous Options for Severe MRSA Infections
For hospitalized patients with complicated infections, recommended IV options include 1:
- Vancomycin (15-20 mg/kg every 8-12 hours) - Standard of care
- Daptomycin (4 mg/kg once daily for skin infections)
- Linezolid (600 mg twice daily)
- Clindamycin IV (600 mg every 8 hours) if susceptible