Treatment of MRSA Wound Infections

Introduction to MRSA Treatment

The Infectious Diseases Society of America recommends incision and drainage as the mainstay of therapy for any abscess or purulent wound infection, which must be performed before or concurrent with antibiotic therapy 1, 2, 3
For simple abscesses without systemic signs, incision and drainage alone may be adequate without antibiotics, as stated by the Infectious Diseases Society of America 3
Obtaining cultures from purulent drainage before starting antibiotics is crucial to confirm MRSA and guide definitive therapy, according to the Infectious Diseases Society of America 2, 3

The American College of Clinical Pharmacy recommends trimethoprim-sulfamethoxazole (Bactrim) 1-2 double-strength tablets (160mg/800mg) orally twice daily for 7-10 days as an effective first-line oral antibiotic option for MRSA wound infections, but incision and drainage must be performed first for any purulent collection 1, 2
Bactrim is appropriate for uncomplicated purulent skin and soft tissue infections after incision and drainage, as recommended by the Infectious Diseases Society of America 1, 4
The Society for Healthcare Epidemiology of America suggests that Bactrim is suitable for mild to moderate MRSA wound infections without systemic toxicity 2, 3

Clindamycin 300-450 mg PO three times daily is preferred over Bactrim when coverage for both MRSA and beta-hemolytic streptococci is needed, as recommended by the Pediatric Infectious Diseases Society 1, 3
The American Academy of Pediatrics recommends clindamycin 10-13 mg/kg/dose every 6-8 hours for treating children with MRSA infections, instead of Bactrim 3
Bactrim should be avoided in infants younger than 2 months, third trimester pregnancy, and polymicrobial abdominal/perineal wounds without adding anaerobic coverage, as stated by the Infectious Diseases Society of America 2, 3, 5

Doxycycline 100 mg twice daily is an alternative oral agent when Bactrim fails or is contraindicated, but it should be avoided in children <8 years and lactating women, as recommended by the American College of Clinical Pharmacy 1, 4, 3
Minocycline 200 mg once, then 100 mg twice daily, is another alternative, which may be more reliable than doxycycline for CA-MRSA, according to the Infectious Diseases Society of America 3
Linezolid 600 mg twice daily is a highly effective but expensive option, which should be used cautiously in lactation, as stated by the Society for Healthcare Epidemiology of America 4, 3