From the Guidelines
The primary treatment for Methicillin-resistant Staphylococcus aureus (MRSA) is incision and drainage for cutaneous abscesses, with antibiotic therapy recommended for severe or extensive disease, or when there are signs of systemic illness.
Treatment Options
- For outpatients with purulent cellulitis, empirical therapy for CA-MRSA is recommended pending culture results, with options including:
- Clindamycin
- Trimethoprim-sulfamethoxazole (TMP-SMX)
- Tetracycline (doxycycline or minocycline)
- Linezolid
- For hospitalized patients with complicated SSTI, empirical therapy for MRSA should be considered pending culture data, with options including:
- Intravenous (IV) vancomycin
- Linezolid 600 mg twice daily
- Daptomycin 4 mg/kg/dose IV once daily
- Telavancin 10 mg/kg/dose IV once daily
- Clindamycin 600 mg IV or PO 3 times a day 1
Duration of Therapy
- The duration of therapy should be individualized based on the patient's clinical response, but generally ranges from 5 to 10 days for outpatients with purulent cellulitis, and 7 to 14 days for hospitalized patients with complicated SSTI 1
Cultures and Antibiotic Resistance
- Cultures from abscesses and other purulent SSTIs are recommended in patients treated with antibiotic therapy, patients with severe local infection or signs of systemic illness, patients who have not responded adequately to initial treatment, and if there is concern for a cluster or outbreak 1
From the Research
Treatment Options for MRSA
The treatment for Methicillin-resistant Staphylococcus aureus (MRSA) depends on the type and severity of the infection.
- For serious MRSA infections, parenteral vancomycin or teicoplanin are recommended 2.
- Alternative treatment options include:
- New lipoglycopeptides (oritavancin, dalbavancin, and telavancin) 3.
- Fifth-generation cephalosporins (ceftaroline and ceftobiprole) 3, 4, 5.
- Tedizolid, which is an attractive agent for use in both hospital and community settings 3, 4.
- Daptomycin and linezolid, which have shown non-inferiority to vancomycin in the treatment of MRSA bacteraemia and non-inferiority/superiority to vancomycin in the treatment of hospital-acquired pneumonia 3.
- Combination therapy with ceftaroline and daptomycin, which has shown better efficacy and treatment outcome compared to traditional standard monotherapy (vancomycin/daptomycin monotherapy) 5.
- For less serious MRSA infections, such as skin and soft tissue infections, treatment options include:
Considerations for Treatment
When selecting a treatment option for MRSA, it is essential to consider the severity of the infection, the patient's medical history, and the potential for antibiotic resistance 3, 2, 6, 5.
- High-dose daptomycin (8-10 mg/kg) therapy is recommended for MRSA bacteremia treatment, especially in cases with vancomycin-reduced susceptibility 5.
- The use of newer agents, such as ceftaroline, as monotherapy or in combination with other antibiotics, requires further study to determine their efficacy and safety in the treatment of MRSA infections 5.