Management of MRSA Skin Infections

Primary Treatment Approach

Incision and drainage is the primary treatment for cutaneous abscesses, and for simple abscesses or boils, incision and drainage alone may be adequate without antibiotics, according to the Infectious Diseases Society of America 1, 4, 5
Antibiotic therapy is recommended for abscesses with severe or extensive disease, rapid progression with associated cellulitis, signs of systemic illness, comorbidities or immunosuppression, extremes of age, abscess in difficult-to-drain areas, associated septic phlebitis, or lack of response to incision and drainage alone, as suggested by the Infectious Diseases Society of America 1, 2, 4

The American College of Physicians recommends clindamycin (300-450 mg three times daily) as a first-line oral antibiotic option for MRSA skin infections, with advantages including coverage of both MRSA and β-hemolytic streptococci, but with caution for potential cross-resistance in erythromycin-resistant strains 1, 3, 6
The Infectious Diseases Society of America suggests trimethoprim-sulfamethoxazole (TMP-SMX) (1-2 double-strength tablets twice daily) as a first-line option, with high effectiveness against MRSA, but limited coverage of β-hemolytic streptococci 6, 7
Tetracyclines, such as doxycycline (100 mg twice daily), are recommended by the American College of Physicians as a first-line option, but are contraindicated in children under 8 years of age 1, 3, 6, 8
Linezolid (600 mg twice daily) is recommended by the Infectious Diseases Society of America for serious infections or when other options fail, with advantages including no cross-resistance with other antibiotic classes, but limitations including high cost 1, 6

The Infectious Diseases Society of America recommends 5-10 days of therapy for most MRSA skin infections, with duration individualized based on clinical response, and 7-14 days for complicated infections 1, 2, 3, 4

For pediatric patients, the American Academy of Pediatrics recommends mupirocin 2% topical ointment for minor skin infections, and clindamycin (10-20 mg/kg/day in 3 divided doses) as a preferred oral antibiotic option 6, 8
For recurrent infections, the Centers for Disease Control and Prevention suggest preventive measures including keeping wounds covered, maintaining good personal hygiene, and considering environmental hygiene measures 4, 8

The Infectious Diseases Society of America advises against using rifampin as a single agent or adjunctive therapy for MRSA skin infections, and against relying on vancomycin for outpatient oral therapy 1, 3, 6
The American College of Physicians recommends obtaining cultures from abscesses in patients receiving antibiotic therapy to guide treatment 1, 5