From the Guidelines
Treatment for MRSA multiple furuncles in the axilla typically requires a combination of incision and drainage (I&D) plus antibiotic therapy. For multiple MRSA furuncles in the axilla, oral antibiotics with MRSA coverage should be initiated, such as trimethoprim-sulfamethoxazole (TMP-SMX) 1-2 double-strength tablets twice daily, doxycycline 100mg twice daily, or clindamycin 300-450mg three times daily for 7-10 days 1. Larger furuncles require incision and drainage as the primary treatment.
Key Considerations
- Topical measures include applying warm compresses to the area for 15 minutes 3-4 times daily to promote drainage and chlorhexidine washes to reduce bacterial colonization.
- For recurrent infections, consider decolonization with intranasal mupirocin 2% ointment applied to both nostrils twice daily for 5 days and chlorhexidine body washes for 5-7 days 1.
- MRSA furuncles are highly contagious, so patients should avoid sharing personal items, cover draining lesions with clean bandages, and wash hands frequently.
- The axillary location is particularly prone to recurrence due to moisture, friction, and bacterial colonization, so maintaining good hygiene in this area is essential for preventing future infections.
Antibiotic Therapy
- Oral antibiotic options for empirical coverage of CA-MRSA in outpatients with SSTI include clindamycin, trimethoprim-sulfamethoxazole (TMP-SMX), a tetracycline (doxycycline or minocycline), and linezolid 1.
- If coverage for both b-hemolytic streptococci and CA-MRSA is desired, options include clindamycin alone or TMP-SMX or a tetracycline in combination with a b-lactam (eg, amoxicillin) or linezolid alone 1.
From the FDA Drug Label
Vancomycin Hydrochloride for Injection, USP is indicated for the treatment of serious or severe infections caused by susceptible strains of methicillin-resistant (β-lactam-resistant) staphylococci Vancomycin Hydrochloride for Injection, USP is effective in the treatment of staphylococcal endocarditis Its effectiveness has been documented in other infections due to staphylococci, including septicemia, bone infections, lower respiratory tract infections, skin and skin structure infections. When staphylococcal infections are localized and purulent, antibiotics are used as adjuncts to appropriate surgical measures
Vancomycin may be used to treat MRSA multiple furuncles in axilla, as it is indicated for the treatment of skin and skin structure infections caused by susceptible strains of methicillin-resistant staphylococci. However, it should be used in conjunction with surgical measures for localized and purulent infections 2.
From the Research
Treatment Options for MRSA Multiple Furuncles in Axilla
- Incision and drainage is often not sufficient for patients with multiple furuncles, and systemic antibiotics may be necessary 3
- The expanded-spectrum tetracyclines, such as doxycycline and minocycline, appear to be a reasonable oral treatment option for patients with community-onset MRSA skin and soft tissue infections, including furuncles 4
- Appropriate management of community-associated MRSA skin and skin structure infections includes incision and drainage of infected tissue and appropriate antimicrobial therapy, with options including minocycline, doxycycline, sulfamethoxazole-trimethoprim, moxifloxacin, levofloxacin, and clindamycin 5
- For purulent skin and soft tissue infections, antibiotic selection in the community should consider the high prevalence of MRSA, with doxycycline or trimethoprim-sulfamethoxazole being suitable options for initial therapy when MRSA is suspected 6
Antibiotic Susceptibility
- MRSA strains are often susceptible to older antibiotics such as minocycline, doxycycline, sulfamethoxazole-trimethoprim, moxifloxacin, levofloxacin, and clindamycin 5
- Doxycycline and trimethoprim-sulfamethoxazole have been shown to be effective against MRSA, with high sensitivity rates 4, 6
- Clindamycin and levofloxacin also have activity against MRSA, although resistance rates may be higher 6
Clinical Considerations
- The selection of antibiotics should be guided by local susceptibility patterns and individual patient factors 5
- Clinicians should be aware of the high prevalence of MRSA in community-acquired skin and soft tissue infections and adjust their antibiotic selection accordingly 6
- Further research is needed to determine the effectiveness of various antibiotics in treating MRSA infections, including furuncles 7