Management of Staph Skin Infections

Treatment Algorithm

• The American College of Physicians recommends Bactrim DS (trimethoprim-sulfamethoxazole 160/800 mg twice daily) as first-line oral therapy for MRSA skin infections for 7-10 days 1
• For MRSA skin infections, the Infectious Diseases Society of America suggests alternative agents include doxycycline 100 mg twice daily when TMP-SMX fails or is contraindicated 1
• Clindamycin 300-600 mg every 8 hours is preferred when coverage for both MRSA and β-hemolytic streptococci is needed, though resistance rates are now very common 2, 3
• The American Academy of Pediatrics recommends dicloxacillin or cephalexin for 7 days as first-line treatment for MSSA skin infections, NOT Bactrim DS 1

Critical Management Principles

• Incision and drainage is mandatory for any abscess or purulent wound infection and must be performed before or concurrent with antibiotic therapy 1
• Obtain cultures from purulent drainage before starting antibiotics to confirm the pathogen and guide definitive therapy 1

Dosing Considerations

• The standard dose (160/800 mg twice daily) is recommended by guidelines for MRSA skin infections 2, 3, 1
• 7-10 days of therapy is recommended for uncomplicated skin infections 3, 1

Special Populations

• Clindamycin 10-13 mg/kg/dose every 6-8 hours is preferred for children with MRSA infections 1
• Avoid doxycycline in children <8 years old due to tooth discoloration and bone growth effects 1, 4

Common Pitfalls to Avoid

• Do not use Bactrim DS empirically for MSSA when dicloxacillin or cephalexin are appropriate 1
• Do not use clindamycin empirically for MRSA without susceptibility testing due to increasing resistance rates 3, 4