IDSA Guidelines on the Treatment of MRSA Infections in Adults and Children (2022)

IDSA Guidelines on the Treatment of MRSA Infections in Adults and Children (1)

MARA LAMBERT

Am Fam Physician. 2011;84(4):455-463

Guideline source: Infectious Diseases Society of America
Evidence rating system used? Yes
Literature search described? Yes
Published source: Clinical Infectious Diseases, February 1, 2011
Available at: http://cid.oxfordjournals.org/content/early/2011/01/04/cid.ciq146.full

The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in the United States continues to increase, with more than 94,000 cases of invasive disease reported in 2005. Illnesses caused by MRSA include skin and soft-tissue infections, bacteremia and endocarditis, pneumonia, bone and joint infections, central nervous system disease, and toxic shock and sepsis syndromes. The Infectious Diseases Society of America (IDSA) has released its first evidence-based guidelines on the treatment of MRSA infections. In addition to common clinical syndromes, the guidelines address treatment with vancomycin, limitations of susceptibility testing, and alternative therapies.

Skin and Soft-Tissue Infections in Community-Associated MRSA

Simple abscesses or boils may be managed with incision and drainage alone; more data are needed on the use of antibiotics in this setting. Antibiotics are recommended for patients who have abscesses associated with severe or extensive disease (e.g., multiple sites of infection) or rapid progression in the presence of associated cellulitis; signs and symptoms of systemic illness; associated comorbidities or immunosuppression; very young or very old age; abscesses in areas difficult to drain (e.g., face, hand, genitalia); associated septic phlebitis; or lack of response to incision and drainage alone. Empiric therapy for five to 10 days is recommended pending culture results for outpatients with purulent cellulitis. Infection from β-hemolytic streptococci does not usually require empiric therapy. For those with nonpurulent cellulitis, five to 10 days of empiric therapy for β-hemolytic streptococcal infection is recommended, based on the patient's clinical response. Empiric coverage for community-associated MRSA is recommended in patients who do not respond to beta-lactam antibiotics, and also may be considered in those with systemic toxicity.

Oral antibiotic options for treating skin and soft-tissue infections in patients with community-associated MRSA include clindamycin, trimethoprim/sulfamethoxazole (TMP/SMX; Bactrim, Septra), a tetracycline (doxycycline or minocycline [Minocin]), and linezolid (Zyvox). Options for treating both β-hemolytic streptococci and community-associated MRSA include clindamycin alone, TMP/SMX or a tetracycline in combination with a beta-lactam antibiotic (e.g., amoxicillin), or linezolid alone. Rifampin is not recommended for use as a single agent or adjunctive therapy.

For hospitalized patients with complicated skin and soft-tissue infections (i.e., deeper soft-tissue infections, surgical or traumatic wound infection, major abscesses, cellulitis, or infected ulcers and burns), empiric therapy for MRSA should be considered pending culture results, in addition to surgical debridement and broad-spectrum antibiotics. Empiric therapy options include intravenous vancomycin, linezolid (600 mg orally or intravenously twice per day), daptomycin (Cubicin; 4 mg per kg intravenously once per day), telavancin (Vibativ; 10 mg per kg intravenously once per day), or clindamycin (600 mg intravenously or orally three times per day). A beta-lactam antibiotic (e.g., cefazolin) may be considered in hospitalized patients with nonpurulent cellulitis. MRSA-active therapy may be modified if there is no clinical response. Treatment for seven to 14 days is recommended, but should be individualized to the patient's clinical response. Cultures from abscesses and other purulent infections are recommended in patients who have received antibiotic therapy, those with severe local infection or signs of systemic illness, and those who have not responded adequately to initial treatment. Cultures are also recommended if there is concern of a cluster or outbreak.

CHILDREN

In children with minor skin infections (e.g., impetigo) or secondarily infected lesions (e.g., eczema, ulcers, lacerations), treatment with mupirocin 2% topical cream (Bactroban) is recommended. Tetracyclines are not recommended for children younger than eight years. Vancomycin is recommended in hospitalized children. If the child is stable without ongoing bacteremia or intravascular infection, empiric therapy with clindamycin (10 to 13 mg per kg intravenously every six to eight hours for a total of 40 mg per kg per day) is an option if the resistance rate is less than 10 percent. If the strain is susceptible, transition to oral therapy is advised. Linezolid may be considered as an alternative (600 mg orally or intravenously twice per day for children 12 years and older; 10 mg per kg orally or intravenously every eight hours for children younger than 12 years).

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Recurrent MRSA Skin and Soft-Tissue Infections

Physicians should provide instructions on personal hygiene and wound care for patients with skin and soft-tissue infections. Patients should cover draining wounds with clean, dry bandages. Regular bathing is advised, as well as hand washing with soap and water or an alcohol-based hand gel, especially after touching infected skin or an item that has been in contact with a draining wound. Patients should also avoid reusing or sharing items that that have touched infected skin (e.g., disposable razors, linens, towels). Commercially available cleaners or detergents should be used to clean high-touch surfaces (e.g., doorknobs, counters, bathtubs, toilet seats) that may come in contact with bare skin or uncovered infections.

Decolonization may be considered if a patient develops a recurrent infection despite good personal hygiene and wound care, or if other household members develop infections. Strategies for decolonization include nasal decolonization with mupirocin twice per day for five to 10 days, or nasal decolonization with mupirocin twice per day for five to 10 days plus topical body decolonization with a skin antiseptic solution (e.g., chlorhexidine [Peridex]) for five to 14 days or dilute bleach baths. Dilute bleach baths can be made with 1 teaspoon of bleach per 1 gallon of water (or one-fourth cup per one-fourth bathtub or 13 gallons of water) and are given for 15 minutes twice per week for three months. Oral antimicrobial therapy is recommended only for treating active infection and is not routinely recommended for decolonization. An oral agent in combination with rifampin, if the strain is susceptible, may be considered if infections recur despite these measures.

If household or interpersonal transmission is suspected, patients and contacts should be instructed to practice personal and environmental hygiene measures. In symptomatic contacts, nasal and topical body decolonization strategies may be considered after treating the active infection. Decolonization strategies also may be considered in asymptomatic household contacts. The role of cultures in managing recurrent skin and soft-tissue infections is limited. Screening cultures before decolonization are not routinely recommended if at least one of the previous infections was caused by MRSA. Surveillance cultures after a decolonization regimen are not routinely recommended if there is no active infection.

MRSA Bacteremia and Infective Endocarditis

BACTEREMIA AND INFECTIVE ENDOCARDITIS, NATIVE VALVE

Uncomplicated bacteremia is defined as positive blood culture results and the following: exclusion of endocarditis; no implanted prostheses; follow-up blood cultures performed on specimens obtained two to four days after the initial set that do not grow MRSA; defervescence within 72 hours of initiating effective therapy; and no evidence of metastatic sites of infection. Recommended treatment for adults with uncomplicated bacteremia includes vancomycin or daptomycin at a dosage of 6 mg per kg intravenously once per day for at least two weeks. For adults with complicated bacteremia (positive blood culture results without meeting criteria for uncomplicated bacteremia), four to six weeks of therapy is recommended, depending on the extent of infection. Some experts recommend higher dosages of daptomycin (8 to 10 mg per kg intravenously once per day).

For adults with infective endocarditis, intravenous vancomycin or daptomycin (6 mg per kg intravenously once per day for six weeks) is recommended. Some experts recommend higher dosages of daptomycin (8 to 10 mg per kg intravenously once per day). Adding gentamicin or rifampin to vancomycin is not recommended in patients with bacteremia or native valve infective endocarditis. A clinical assessment to identify the source and extent of the infection with elimination and/or debridement of other sites of infection is recommended. Additional blood cultures two to four days after initial positive cultures and as needed thereafter are recommended to document clearance of bacteremia. Echocardiography is recommended for all adults with bacteremia. Transesophageal echocardiography is preferred over transthoracic echocardiography. Evaluation for valve replacement surgery is recommended if any of the following are present: large vegetation (greater than 10 mm in diameter), occurrence of one or more embolic events during the first two weeks of therapy, severe valvular insufficiency, valvular perforation or dehiscence, decompensated heart failure, perivalvular or myocardial abscess, new heart block, or persistent fevers or bacteremia.

INFECTIVE ENDOCARDITIS, PROSTHETIC VALVE

Patients with infective endocarditis and a prosthetic valve should be treated with intravenous vancomycin and rifampin (300 mg orally or intravenously every eight hours for at least six weeks), plus gentamicin (1 mg per kg intravenously every eight hours for two weeks). Early evaluation for valve replacement surgery is recommended.

CHILDREN

In children, intravenous vancomycin (15 mg per kg every six hours) is recommended for treating bacteremia and infective endocarditis. The duration of therapy may range from two to six weeks depending on the source, the presence of endovascular infection, and metastatic foci of infection. Data regarding the safety and effectiveness of alternative agents in children are limited, although daptomycin (6 to 10 mg per kg intravenously once per day) may be an option. Clindamycin and linezolid should not be used if there is concern of infective endocarditis or an endovascular source of infection, although they may be considered in children with bacteremia that rapidly clears and is not related to an endovascular focus. Data are insufficient to support the routine use of combination therapy with rifampin or gentamicin in children with bacteremia or infective endocarditis. The decision to use combination therapy should be individualized. Echocardiography is recommended in children with congenital heart disease, bacteremia lasting more than two to three days, or other clinical findings suggestive of endocarditis.

MRSA Pneumonia

PNEUMONIA

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Empiric therapy for MRSA is recommended, pending sputum and/or blood culture results, for hospitalized patients with severe community-acquired pneumonia defined by one of the following: a requirement for admission to the intensive care unit, necrotizing or cavitary infiltrates, or empyema. Treatment options for health care–associated MRSA or community-associated MRSA pneumonia include seven to 21 days of intravenous vancomycin or linezolid, or clindamycin (600 mg orally or intravenously three times per day) if the strain is susceptible. In patients with MRSA pneumonia complicated by empyema, antimicrobial therapy should be used with drainage procedures.

CHILDREN

In children, intravenous vancomycin is recommended for treating MRSA pneumonia. If the patient is stable without ongoing bacteremia or intravascular infection, clindamycin (10 to 13 mg per kg intravenously every six to eight hours for a total of 40 mg per kg per day) can be used as empiric therapy if the clindamycin resistance rate is low (e.g., less than 10 percent). Patients can be transitioned to oral therapy if the strain is susceptible. Linezolid is an alternative option.

MRSA Bone and Joint Infections

OSTEOMYELITIS

The mainstay of therapy for osteomyelitis is surgical debridement with drainage of associated soft-tissue abscesses. The optimal route of administration of antibiotic therapy has not been established; parenteral, oral, or initial parenteral therapy followed by oral therapy may be used, depending on patient circumstances. Antibiotic options for parenteral administration include intravenous vancomycin and daptomycin (6 mg per kg intravenously once per day). Antibiotic options with parenteral and oral routes of administration include the following: TMP/SMX (4 mg per kg [TMP component] twice per day) in combination with rifampin (600 mg once per day), linezolid, and clindamycin (600 mg every eight hours). Some experts recommend adding oral rifampin (600 mg per day, or 300 to 450 mg twice per day) to the chosen antibiotic. For patients with concurrent bacteremia, rifampin should be added after bacteremia has cleared.

The optimal duration of therapy for MRSA osteomyelitis is unknown, although a minimum of eight weeks is recommended. Some experts suggest an additional one to three months (and possibly longer for chronic infection or if debridement is not performed) of oral rifampin-based combination therapy with TMP/SMX, doxycycline, minocycline, clindamycin, or a fluoroquinolone, chosen based on susceptibilities. Magnetic resonance imaging with gadolinium is the imaging modality of choice for detecting early osteomyelitis and associated soft-tissue disease. Measuring erythrocyte sedimentation rate, C-reactive protein level, or both may help guide the response to therapy.

SEPTIC ARTHRITIS

Drainage or debridement of the joint space should be performed. For patients with septic arthritis, the antibiotic choices for osteomyelitis are recommended; a three- to four-week course of therapy is suggested.

DEVICE-RELATED OSTEOARTICULAR INFECTIONS

For patients with early-onset (less than two months after surgery) or acute hematogenous prosthetic joint infections involving a stable implant with short duration of symptoms (three weeks or less) and debridement (but device retention), parenteral therapy should be initiated (see antibiotic recommendations for osteomyelitis) plus rifampin (600 mg per day, or 300 to 450 mg orally twice per day for two weeks), followed by rifampin plus a fluoroquinolone, TMP/SMX, a tetracycline, or clindamycin for three months for hips and six months for knees. Prompt debridement with device removal is recommended for unstable implants or late-onset infections, or in patients with more than three weeks of symptoms.

For early-onset spinal implant infections (30 days or less after surgery) or implants in an actively infected site, initial parenteral therapy plus rifampin followed by prolonged oral therapy is recommended. The optimal duration of parenteral and oral therapy is unclear; oral therapy should be continued until spinal fusion has occurred.

For late-onset infections (more than 30 days after surgery), device removal is recommended. Long-term oral suppressive antibiotics (e.g., TMP/SMX, a tetracycline, a fluoroquinolone in conjunction with rifampin, clindamycin) with or without rifampin may be considered, particularly if device removal is not possible.

CHILDREN

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Vancomycin is recommended in children with acute hematogenous MRSA osteomyelitis and septic arthritis. If the patient is stable without ongoing bacteremia or intra-vascular infection, clindamycin (10 to 13 mg per kg intravenously every six to eight hours for a total of 40 mg per kg per day) can be used as empiric therapy if the resistance rate is low (e.g., less than 10 percent), with transition to oral therapy if the strain is susceptible. The duration of therapy should be individualized, but a minimum of three to four weeks is recommended for patients with septic arthritis, and four to six weeks for patients with osteomyelitis. Daptomycin (6 mg per kg intravenously once per day) and linezolid are alternative therapies.

MRSA Infections of the Central Nervous System

MENINGITIS

The recommended treatment for patients with meningitis is intravenous vancomycin for two weeks. Some experts recommend adding rifampin (600 mg per day, or 300 to 450 mg twice per day). Alternatives include linezolid or TMP/SMX (5 mg per kg intravenously every eight to 12 hours). Shunt removal is recommended in cases of central nervous system shunt infection, and the shunt should not be replaced until cerebrospinal fluid cultures are repeatedly negative.

BRAIN ABSCESS, SUBDURAL EMPYEMA, AND SPINAL EPIDURAL ABSCESS

Neurosurgical evaluation for incision and drainage is recommended for patients with brain abscess, subdural empyema, or spinal epidural abscess. Recommended treatment is intravenous vancomycin for four to six weeks. Some experts recommend adding rifampin. Alternatives include linezolid and TMP/SMX.

SEPTIC THROMBOSIS OF CAVERNOUS OR DURAL VENOUS SINUS

Surgical evaluation for incision and drainage of contiguous sites of infection or abscess is recommended. The role of anticoagulation is controversial. Recommended treatment is intravenous vancomycin for four to six weeks. Some experts recommend adding rifampin. Alternatives include linezolid and TMP/SMX.

CHILDREN

Children with MRSA infections of the central nervous system should be treated with intravenous vancomycin.

Protein synthesis inhibitors (e.g., clindamycin, linezolid) and intravenous immune globulin are not routinely recommended as adjunctive therapy for the management of invasive MRSA disease, although they may be considered in certain scenarios (e.g., necrotizing pneumonia, severe sepsis).

Vancomycin Dosing and Monitoring

Recommendations for vancomycin dosing are based on a consensus statement of the American Society of Health-System Pharmacists, the IDSA, and the Society of Infectious Diseases Pharmacists.

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ADULTS

In patients with normal renal function, intravenous vancomycin (15 to 20 mg per kg every eight to 12 hours) is recommended, but should not exceed 2 g per dose. In seriously ill patients (e.g., those with sepsis, meningitis, pneumonia, or infective endocarditis) with suspected MRSA infection, a loading dose of 25 to 30 mg per kg may be considered. Because of the risk of red man syndrome and possible anaphylaxis associated with large doses of vancomycin, physicians should consider prolonging the infusion time to two hours and giving an antihistamine before administering the loading dose.

Use of trough vancomycin concentrations is the most accurate and practical method to guide vancomycin dosing. Serum trough concentrations should be obtained at steady state conditions, before the fourth or fifth dose. Monitoring peak vancomycin concentrations is not recommended. Vancomycin trough concentrations of 15 to 20 mcg per mL are recommended in patients with serious infections, such as bacteremia, infective endocarditis, osteomyelitis, meningitis, pneumonia, or severe skin and soft-tissue infections (e.g., necrotizing fasciitis) caused by MRSA. For most patients with skin and soft-tissue infections who have normal renal function and are not obese, traditional dosages of 1 g every 12 hours are adequate, and trough monitoring is not required. Trough vancomycin monitoring is recommended for patients with serious infections or who are morbidly obese, have renal dysfunction (including those receiving dialysis), or have fluctuating volumes of distribution. A regimen of continuous infusion is not recommended.

CHILDREN

Data on vancomycin dosing in children are limited. The recommended treatment is vancomycin (15 mg per kg intravenously every six hours) in children with serious or invasive disease. The effectiveness and safety of targeting trough concentrations of 15 to 20 mcg per mL in children require additional study, but should be considered in those with serious infections, such as bacteremia, infective endocarditis, osteomyelitis, meningitis, pneumonia, or severe skin and soft-tissue infections.

Vancomycin Susceptibility Testing for Guiding Therapy

For isolates with a vancomycin minimal inhibitory concentration of 2 mcg per mL or less (e.g., susceptible according to Clinical and Laboratory Standards Institute breakpoints), the patient's clinical response should dictate the continued use of vancomycin, independent of the minimal inhibitory concentration. If the patient has had a previous clinical and microbiologic response to vancomycin, it may be continued with close follow-up. If the patient has not responded to vancomycin therapy despite adequate debridement and removal of other foci of infection, an alternative agent is recommended. For isolates with a vancomycin minimal inhibitory concentration greater than 2 mcg per mL (e.g., vancomycin-intermediate S. aureus, vancomycin-resistant S. aureus), an alternative agent should be prescribed.

Persistent MRSA Bacteremia and Vancomycin Treatment Failures in Adults

A search for and removal of other foci of infection, drainage, or surgical debridement is recommended. High-dose daptomycin (10 mg per kg per day), if the isolate is susceptible, in combination with another agent (e.g., gentamicin, rifampin, linezolid, TMP/SMX, a beta-lactam antibiotic) should be considered. If reduced susceptibility to vancomycin and daptomycin is present, alternative treatment options include dalfopristin/quinupristin (Synercid; 7.5 mg per kg intravenously every eight hours), TMP/SMX, linezolid, or telavancin. These may be given as a single agent or in combination with other antibiotics.

MRSA Infections in Neonates

NEONATAL PUSTULOSIS

For mild cases of pustulosis with localized disease, topical treatment with mupirocin may be adequate in full-term neonates and young infants. For localized disease in a premature or very low-birth-weight infant or more extensive disease involving multiple sites in full-term infants, intravenous vancomycin or clindamycin is recommended until bacteremia is excluded.

NEONATAL MRSA SEPSIS

Recommended treatment of neonatal MRSA sepsis is intravenous vancomycin, with dosing as outlined in Red Book. Clindamycin and linezolid are alternative treatments for nonendovascular infections.

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FAQs

What is the first line antibiotic for the treatment of MRSA? ›

Vancomycin or daptomycin are the agents of choice for treatment of invasive MRSA infections [1]. Alternative agents that may be used for second-line or salvage therapy include telavancin, ceftaroline, and linezolid.

What is the current treatment for MRSA? ›

At home — Treatment of MRSA at home usually includes a 7- to 10-day course of an antibiotic (by mouth) such as trimethoprim-sulfamethoxazole (brand name: Bactrim), clindamycin, minocycline, linezolid, or doxycycline.

How is MRSA treated CDC? ›

Many staph skin infections may be treated by draining the abscess or boil and may not require antibiotics. Drainage of skin boils or abscesses should only be done by a healthcare provider. Do not try to drain the infection yourself. However, some staph and MRSA infections are treated with antibiotics.

What is the most effective antibiotic for MRSA? ›

Vancomycin is generally considered the drug of choice for severe CA-MRSA infections. Although MRSA is usually sensitive to vancomycin, strains with intermediate susceptibility, or, more rarely, resistant strains have been reported.

How is MRSA treated in children? ›

Your child will likely be treated with antibiotic medicine. If your child has a mild MRSA skin infection, the healthcare provider will likely treat it by opening the infected sore and draining out the fluid (pus). You will likely be given a prescription antibiotic ointment to use on your child.

How long do you treat MRSA with vancomycin? ›

Recommended treatment is intravenous vancomycin for four to six weeks. Some experts recommend adding rifampin. Alternatives include linezolid and TMP/SMX.

Does IV doxycycline cover MRSA? ›

Reasonable antibiotics for treatment of MRSA include older agents (clindamycin, trimethoprim- sulfamethoxazole, and tetracyclines such as doxycycline or minocycline) and a newer agent, linezolid (table 1).

Is doxycycline effective for MRSA? ›

Oral antibiotics belonging to the tetracycline family, including minocycline and doxycycline, provide an effective means of treating CA-MRSA infections. As stated above, incision and drainage remains the single most important intervention against CA-MRSA infections, which present as abscess-like lesions.

Does Bactrim cover MRSA? ›

Few antibiotics are available to treat more serious MRSA infections. These include vancomycin (Vancocin, Vancoled), trimethoprim-sulfamethoxazole (Bactrim, Bactrim DS, Septra, Septra DS) and linezolid (Zyvox).

What is the difference between community acquired MRSA and hospital acquired MRSA? ›

The Community acquired MRSA occurs in individuals in the community, who are generally healthy and who were not receiving healthcare in a hospital or on an ongoing outpatient basis. The HA-MRSA refers to the hospital or healthcare acquired methicillin resistant Staphylococcus aureus.

Should patients with MRSA be isolated? ›

Use Contact Precautions when caring for patients with MRSA (colonized, or carrying, and infected). Contact Precautions mean: Whenever possible, patients with MRSA will have a single room or will share a room only with someone else who also has MRSA.

Why is methicillin no longer used? ›

Methicillin. Methicillin was the first semisynthetic penicillinase-resistant penicillin. It has been withdrawn from the market in the United States because of the high incidence of interstitial nephritis associated with its use.

What 3 antibiotics is MRSA resistant to? ›

What sets MRSA apart is that it is resistant to an entire class of antibiotics called beta-lactams. This group of antibiotics includes methicillin, and the more commonly prescribed penicillin, amoxicillin, and oxacillin among others.

What is the fastest way to get rid of MRSA? ›

Vancomycin or daptomycin are the agents of choice for the treatment of invasive MRSA infections. Vancomycin is considered to be one of the powerful antibiotics which is usually used in treating MRSA.

What is the best antibiotic for Staphylococcus aureus? ›

aureus (MRSA) are common in hospitals and are emerging in the community. Penicillinase-resistant penicillins (flucloxacillin, dicloxacillin) remain the antibiotics of choice for the management of serious methicillin-susceptible S.

What antibiotics treat staph in children? ›

The study primarily evaluated the antibiotics clindamycin and trimethoprim-sulfamethoxazole (TMP-SMX). Of the two drugs, clindamycin was the most effective at eliminating staph colonization and preventing recurrent infection.

Is mupirocin used for MRSA? ›

Mupirocin is a commonly used antibiotic for decolonization of MRSA in carriers and for treatment of skin and soft tissue infections caused by MRSA.

How serious is MRSA in children? ›

It can be life-threatening if it spreads to the lungs, the bloodstream, or other organs. MRSA infection can be harder to treat than other staph infections. But other oral or IV (intravenous) antibiotics can successfully treat the infection.

Why is vancomycin best for MRSA? ›

The current first-line treatment for MRSA has been in use since 1958. That first-line treatment, the antibiotic vancomycin, can keep MRSA from spreading in some cases by preventing the construction of new bacterial cell walls, thus preventing the bacteria from reproducing.

What if vancomycin doesn't work for MRSA? ›

Severe MRSA infections with vancomycin MIC 1.5-2.0 (so-called hVISA) not responding to vancomycin therapy, consider an alternative agent (e.g., daptomycin or ceftaroline). Several studies have worse clinical outcomes with vancomycin in these settings.

Does Cipro treat MRSA? ›

Conclusion: Ciprofloxacin can no longer be used in empirical therapy against MRSA infections. Use of other members of fluoroquinolone should be limited only to those strains that show laboratory confirmation of their susceptibility. Vancomycin remains the drug of choice to treat MRSA infections.

What are 3 indications for doxycycline? ›

Doxycycline is a prescription antibiotic medication indicated for the treatment of the following infections and diseases:
  • Rocky Mountain spotted fever,
  • typhus fever and the typhus group,
  • Q fever,
  • rickettsialpox,
  • tick fevers,
  • respiratory tract infections,
  • urinary tract infections.
  • lymphogranuloma venereum,

Will Keflex treat MRSA? ›

Treatment. Commonly used oral antistaphylococcal antibiotics include the first-generation cephalosporins like Keflex (cephalexin) and Duricef (cefadroxil). As resistance to antibiotics is now common among staph bacteria, including MRSA, the first antibiotic prescribed may not work.

Is Augmentin effective against MRSA? ›

Augmentin is effective in treating MSSA infection, but is not effective against MRSA.

Does metronidazole treat MRSA? ›

Interestingly, a series of 35 metronidazole-triazole hybrids on screening against MRSA were found to be active. Compound 22 was found to be effective at 4 μg/mL concentration against nine strains of MRSA.

How does apple cider vinegar cure MRSA? ›

How do I treat or prevent an infection with MRSA (methicillin-resistant Staph aureus)?
  1. Mix 1-2 tablespoon(s) of white or yellow vinegar to 8oz. ...
  2. Soak gauze in the solution and apply to wound area 2-3 times a day for 20 minutes. ...
  3. Pat dry with gauze, do not apply any ointment.

Does Levaquin treat MRSA? ›

Erythromycin (Ery-tab, PCE) and cephalexin (Keflex) are ineffective against MRSA, and ciprofloxacin (Cipro) and levofloxacin (Levaquin) are to be avoided because rates of MRSA infection are increased in hospitalized patients treated with quinolones.

Does TMP SMX cover MRSA? ›

TMP/SMX was the most commonly used oral antimicrobial agent for treating MRSA SSTIs in the study population.

Does SMZ TMP treat MRSA? ›

Trimethoprim-sulfamethoxazole is recommended for the treatment of uncomplicated skin and soft tissue infections but not for MRSA bacteraemia or pneumonia.

Is Bactrim safe for children? ›

This medication should not be used by children less than 2 months of age due to the risk of serious side effects. This medication treats only certain types of infections. It will not work for viral infections (such as flu). Unnecessary use or misuse of any antibiotic can lead to its decreased effectiveness.

How long is a person contagious with MRSA? ›

Typically 4–10 days Contagious Period As long as the bacteria are present in nose, throat and mouth secretions. Do not squeeze or “pop” boils or pimples. Cover with a clean, dry bandage and refer to a health care provider for diagnosis and treatment.

What are the 2 types of MRSA? ›

The two main types of MRSA include healthcare-associated MRSA (HA MRSA), which is found mainly in hospital patients and long-term care facility residents, and community-associated MRSA (CA MRSA), which is found in those who have not had contact with healthcare facilities.

How do you know if MRSA is in your bloodstream? ›

How do I know if I have MRSA? Your doctor may take a sample from your infected skin, nose, blood, urine or saliva and send it to the lab. This test sample is called a “culture”. If the lab finds MRSA in the test sample, the test is positive; this means that you have MRSA in or on your body.

What precautions should be taken for MRSA? ›

To help prevent the spread of MRSA infections:
  • Wash your hands. Use soap and water or an alcohol-based sanitizer. ...
  • Take showers. Shower immediately after exercise. ...
  • Use barriers. Cover cuts and scrapes with a bandage to keep germs out. ...
  • Wash your clothing and equipment.

When do you stop isolation for MRSA? ›

Negative for MRSA? Contact Infection Prevention Department and discontinue isolation Patient off of antibiotics for at least 3 days? Contact Infection Prevention Department & discontinue isolation Consult Infectious Disease MD and, if ordered, treat with antibiotics for 5 days.

Is MRSA airborne or droplet precautions? ›

MRSA is usually spread through physical contact - not through the air. It is usually spread by direct contact (e.g., skin-to-skin) or contact with a contaminated object. However, it can be spread in the air if the person has MRSA pneumonia and is coughing.

What replaced methicillin? ›

Doyle and co-inventors in 1960. Methicillin is a narrow-spectrum drug that has been replaced by more stable and efficacious penicillin derivatives.

What is the gold standard for isolating and identifying MRSA? ›

The PCR assay is considered to be the gold standard for the detection of MRSA.

Is MRSA sensitive to vancomycin? ›

The MRSA patients were sensitive to vancomycin, with the minimum inhibitory concentration (MIC) being 1 μg/mL in 53.80% of the cases and 2 μg/mL in 44.10% of the cases, respectively. Among the 35 (25%) cases treated with vancomycin, 23 were cured, while 3 died and 7 (20%) were considered as an unreasonable application.

What is the fastest way to get rid of MRSA? ›

Vancomycin or daptomycin are the agents of choice for the treatment of invasive MRSA infections. Vancomycin is considered to be one of the powerful antibiotics which is usually used in treating MRSA.

Which antibiotic is most effective against Staphylococcus aureus? ›

Based on our data, the best empiric outpatient antibiotics for presumed S aureus SSTIs are linezolid, trimethoprim sulfamethoxazole or tetracyclines. Clindamycin could be used as an alternative agent if there were contraindications to the first line agents.

Why is vancomycin used for MRSA? ›

The relative high burden of methicillin-resistant S. aureus (MRSA) in healthcare and community settings is a major concern worldwide. Vancomycin, a glycopeptide antibiotic that inhibits cell wall biosynthesis, remains a drug of choice for treatment of severe MRSA infections.

Is mupirocin used for MRSA? ›

Mupirocin is a commonly used antibiotic for decolonization of MRSA in carriers and for treatment of skin and soft tissue infections caused by MRSA.

What detergent kills MRSA? ›

Lysol® kills 99.9% of viruses & bacteria, including MRSA!

How long is a person contagious with MRSA? ›

Typically 4–10 days Contagious Period As long as the bacteria are present in nose, throat and mouth secretions. Do not squeeze or “pop” boils or pimples. Cover with a clean, dry bandage and refer to a health care provider for diagnosis and treatment.

What disinfectant kills MRSA? ›

Household cleaning

Cleanliness is important in the control of germs. To kill MRSA on surfaces, use a disinfectant such as Lysol or a solution of bleach. Use enough solution to completely wet the surface and allow it to air dry.

Does Bactrim have MRSA coverage? ›

Few antibiotics are available to treat more serious MRSA infections. These include vancomycin (Vancocin, Vancoled), trimethoprim-sulfamethoxazole (Bactrim, Bactrim DS, Septra, Septra DS) and linezolid (Zyvox).

Is Augmentin effective against MRSA? ›

Augmentin is effective in treating MSSA infection, but is not effective against MRSA.

Does metronidazole treat MRSA? ›

Interestingly, a series of 35 metronidazole-triazole hybrids on screening against MRSA were found to be active. Compound 22 was found to be effective at 4 μg/mL concentration against nine strains of MRSA.

Why is vancomycin a last resort drug? ›

Vancomycin has long been considered a drug of last resort, due to its efficiency in treating multiple drug-resistant infectious agents and the requirement for intravenous administration. Recently, resistance to even vancomycin has been shown in some strains of S. aureus (sometimes referred to as vancomycin resistant S.

Is doxycycline good for MRSA? ›

Oral antibiotics belonging to the tetracycline family, including minocycline and doxycycline, provide an effective means of treating CA-MRSA infections. As stated above, incision and drainage remains the single most important intervention against CA-MRSA infections, which present as abscess-like lesions.

Is clindamycin good for MRSA? ›

Clindamycin (300 to 450 mg every six to eight hours) has good activity against MRSA and is also capable of inhibiting bacterial production of toxins including Panton-Valentine leukocidin and other virulence factors [14].

Can Bactroban treat MRSA? ›

Bactroban Nasal Ointment is a prescription medicine used to treat the symptoms of Impetigo, skin infections, and MRSA colonization.

What topical cream is good for MRSA? ›

In addition to oral antibiotics, a doctor may prescribe a topical antibiotic ointment. This is usually mupirocin (Bactroban). Bactroban is applied on the inner parts of the nose to reduce the amount of MRSA. Doctors often recommend all family members in a household use the ointment, too.

How do you decolonize MRSA? ›

Decolonisation treatment regimen
  1. Body wash. Daily for 5 days. ...
  2. Nasal ointment. Twice daily for 5 days – use mupirocin 2 per cent (3g bactroban tube). ...
  3. Dentures. Patients with dentures should soak them overnight in a denture cleaning product, for example Steradent or Polident.
  4. Patients with known throat carriage.
1 Mar 2022

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