From the Guidelines
The best treatment for MRSA typically involves antibiotics that are effective against this resistant bacteria, with vancomycin being the first-line treatment for serious infections, and oral antibiotics like trimethoprim-sulfamethoxazole, clindamycin, or linezolid for less severe skin infections, as recommended by the Infectious Diseases Society of America 1.
Key Considerations
- For cutaneous abscesses, incision and drainage is the primary treatment, with antibiotic therapy recommended for abscesses associated with severe or extensive disease, systemic illness, or lack of response to incision and drainage alone 1.
- For outpatients with purulent cellulitis, empirical therapy for CA-MRSA is recommended, with options including clindamycin, trimethoprim-sulfamethoxazole, doxycycline, or linezolid 1.
- For hospitalized patients with complicated SSTI, empirical therapy for MRSA should be considered, with options including intravenous vancomycin, linezolid, daptomycin, telavancin, or clindamycin 1.
Treatment Options
- Vancomycin: 15-20 mg/kg every 8-12 hours for adults, with treatment duration typically 7-14 days depending on infection severity 1.
- Trimethoprim-sulfamethoxazole: one double-strength tablet twice daily for 7-10 days 1.
- Clindamycin: 300-450 mg three times daily for 7-10 days 1.
- Linezolid: 600 mg twice daily for 7-10 days 1.
Important Notes
- Treatment should always be guided by culture and sensitivity testing to ensure the chosen antibiotic is effective against the specific MRSA strain 1.
- Good hygiene practices, including regular handwashing and keeping wounds covered, are essential to prevent spread during treatment.
- MRSA is resistant to traditional beta-lactam antibiotics, which is why these specialized antibiotics are needed 1.
From the FDA Drug Label
The overall Adjudication Committee success rates in the ITT population were 44. 2% (53/120) in patients treated with daptomycin for injection and 41.7% (48/115) in patients treated with comparator (difference = 2.4% [95% CI −10.2,15.1]). The success rates in the PP population were 54.4% (43/79) in patients treated with daptomycin for injection and 53.3% (32/60) in patients treated with comparator (difference = 1.1% [95% CI −15.6,17. 8]). Among patients with MRSA, the success rate was 44% (20/45) for daptomycin for injection and 32% (14/44) for comparator.
The best treatment for MRSA is not explicitly stated in the provided drug label, but daptomycin for injection shows a success rate of 44% in treating MRSA, compared to 32% for the comparator (vancomycin or an anti-staphylococcal semi-synthetic penicillin) 2.
- Key points:
- Daptomycin for injection has a success rate of 44% in treating MRSA.
- The comparator has a success rate of 32% in treating MRSA.
- The difference in success rates between daptomycin for injection and the comparator is 12.6% (95% CI −10.2,35.5).
From the Research
Treatment Options for MRSA
- Vancomycin, quinupristin-dalfopristin, linezolid, tigecycline, telavancin, ceftaroline, and daptomycin are effective drugs for treating MRSA infections, with little resistance observed 3
- Linezolid is likely the drug of choice for complicated MRSA skin and soft tissue infections (SSTIs), but its use in pneumonia is debatable 3
- Daptomycin has shown to be non-inferior to vancomycin or β-lactams in treating staphylococcal SSTIs, bacteremia, and right-sided endocarditis 3
Comparison of Treatment Options
- A systematic review and meta-analysis found that linezolid is comparable to vancomycin, teicoplanin, or daptomycin in terms of effectiveness and safety for treating MRSA bacteremia 4
- A network meta-analysis found that linezolid is superior to vancomycin in improving clinical and microbiological success in MRSA-caused SSTIs, with no significant differences in safety 5
- A retrospective study found that daptomycin and vancomycin appear equally efficacious for MRSA bacteremia, while linezolid therapy was associated with higher mortality 6
Emerging Therapies
- Several drugs with broad-spectrum activity against Gram-positive organisms, including oritavancin, dalbavancin, omadacycline, tedizolid, delafloxacin, and JNJ-Q2, are in the pipeline for clinical use 3
- Ceftaroline, a broad-spectrum cephalosporin with activity against MRSA, has been shown to be non-inferior to vancomycin in treating SSTIs 3, 7