What is the recommended treatment for Methicillin-resistant Staphylococcus aureus (MRSA) infected hair follicle on the leg?

From the Guidelines

For MRSA-infected hair follicles on the leg, treatment typically involves a combination of topical and oral antibiotics, with the recommended approach starting with mupirocin (Bactroban) 2% ointment applied to the affected area three times daily for 7-10 days, as suggested by the guidelines 1.

Key Considerations

• The primary treatment for a cutaneous abscess, such as an MRSA-infected hair follicle, is incision and drainage, but additional antibiotic therapy may be necessary for more severe infections or those with specific conditions such as systemic illness or immunosuppression 1.
• For outpatients with purulent cellulitis, empirical therapy for CA-MRSA is recommended pending culture results, with options including clindamycin, trimethoprim-sulfamethoxazole (TMP-SMX), a tetracycline (doxycycline or minocycline), and linezolid 1.
• The use of rifampin as a single agent or as adjunctive therapy for the treatment of SSTI is not recommended due to the risk of resistance development 1.

Recommended Treatment Approach

• Start with mupirocin (Bactroban) 2% ointment applied to the affected area three times daily for 7-10 days.
• For more severe infections, consider adding oral antibiotics effective against MRSA, such as:
  • Trimethoprim-sulfamethoxazole (Bactrim DS) one tablet twice daily for 7-10 days.
  • Clindamycin 300-450 mg four times daily for 7-10 days.
  • Doxycycline 100 mg twice daily for 7-10 days.
• Apply warm compresses to the area for 15 minutes, 3-4 times daily, to help draw out the infection.
• Keep the area clean by washing with antibacterial soap and avoid shaving the affected area until healed.
• If the folliculitis is accompanied by an abscess, incision and drainage may be necessary before antibiotics will be effective.

Important Notes

• MRSA is resistant to many common antibiotics, which is why specific antibiotics known to be effective against this strain are recommended.
• If symptoms worsen, develop fever, or the infection spreads despite treatment, seek immediate medical attention as more aggressive treatment may be needed.
• 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 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 The recommended treatment for MRSA infected hair follicle on leg is linezolid or vancomycin, with cure rates of 79% and 73% respectively, in patients with MRSA skin and skin structure infections 2.

• Linezolid: 600 mg q12h IV or orally for 7 to 28 days
• Vancomycin: 1 g q12h IV for 7 to 28 days

From the Research

Treatment Options for MRSA Infected Hair Follicle on Leg

• The treatment of MRSA infected hair follicle on leg can involve various antibiotics, including clindamycin, doxycycline, and linezolid, which offer good bioavailability and tissue penetration 3.
• Incision and drainage, in addition to antibiotic treatment, may be necessary for the management of MRSA skin infections, including those affecting hair follicles on the leg 4.
• Malleable liposomes carrying chloramphenicol have shown potential in targeting hair follicles and treating MRSA-infected dermatologic conditions, including those affecting the leg 5.
• There is limited evidence to support the use of specific antibiotics, such as co-trimoxazole, clindamycin, doxycycline, and minocycline, in the treatment of MRSA pneumonia, but they may be considered for MRSA skin infections, including those affecting hair follicles on the leg 6.

Antibiotic Treatment

• Clindamycin, doxycycline, and linezolid are oral antibiotics that can be effective against MRSA infections, including those affecting hair follicles on the leg 3, 7.
• Trimethoprim-sulfamethoxazole (TMP-SMX) is another oral antibiotic that may be used to treat MRSA skin infections, including those affecting hair follicles on the leg 4, 6.
• The choice of antibiotic should be based on the severity of the infection, patient comorbidities, and susceptibility results 3, 7.

Hair Follicle Targeting

• Malleable liposomes carrying chloramphenicol have shown increased follicular uptake and antibacterial activity against MRSA, making them a potential treatment option for MRSA-infected hair follicles on the leg 5.
• The use of liposomes or other targeted delivery systems may improve the efficacy of antibiotic treatment for MRSA-infected hair follicles on the leg 5.