Treatment of Possible MRSA Skin Infection

Introduction to MRSA Treatment

The Infectious Diseases Society of America guidelines recommend oral clindamycin 600 mg three times daily as a first-line option for empirical coverage of community-acquired MRSA in outpatients with skin and soft tissue infections 1, 2.
Oral clindamycin provides the advantage of covering both MRSA and beta-hemolytic streptococci as monotherapy, eliminating the need for combination therapy 1, 3.

You should only use clindamycin if your local clindamycin resistance rate is <10% 1, 2, 3, 4.
If resistance rates are higher or unknown, choose trimethoprim-sulfamethoxazole or doxycycline/minocycline instead 1, 2.

Treat for 5-10 days for uncomplicated infections, adjusting based on clinical response 1, 2, 3, 4.
Incision and drainage is the mainstay of therapy for abscesses - antibiotics are adjunctive 5, 3.

The Infectious Diseases Society of America specifies you should use antibiotics for abscesses or skin infections with severe or extensive disease involving multiple sites 1.
Antibiotics are also indicated for rapid progression with associated cellulitis 1.
Signs of systemic illness (fever, tachycardia, hypotension) also warrant antibiotic use 2.
Immunosuppression or comorbidities (diabetes, HIV) are additional indications for antibiotics 1.
Extremes of age and difficult-to-drain locations (face, hand, genitalia) also require antibiotic therapy 1.
Lack of response to drainage alone is another indication for antibiotics 1.

Trimethoprim-sulfamethoxazole (TMP-SMX) is an excellent alternative for MRSA coverage but requires addition of a beta-lactam (like amoxicillin) if streptococcal coverage is needed 4.
Doxycycline or minocycline are effective alternatives, also requiring beta-lactam addition for streptococcal coverage 2.
Linezolid covers both MRSA and streptococci but is significantly more expensive 4.