Oral Antibiotics to treat MRSA
Remember: BCD – Bactrim, Clinda, and Doxy
Bactrim DS (160/800) po BID
Clindamycin 300 mg po three times per day
Doxycycline 100 mg po BID. Minocycline may also be used.
Regardless of medication choice, treat for 5 to 10 days.
Note: Clindamycin (300 to 450 mg every six to eight hours) has good activity against MRSA. Because Clinda comes in 150 or 300 tabs, I choose to go with 300 three times per day.
Linezolid or tedizolid also come as po and have been shown to work just as effectively as vancomycin to treat MRSA skin infections. However, it’s too expensive and has toxicity. It should be reserved for those who do not respond to or cannot tolerate an older agent.
“Follow-up — Repeat evaluation after 24 to 48 hours of outpatient empiric oral antibiotic therapy is prudent to verify clinical response. The appropriate duration of therapy is one to two weeks; the clinical response to therapy should guide antibiotic duration. Lack of response may be due to infection with resistant pathogens or a deeper, more serious infection than previously realized.” Uptodate.com
Parenteral Antibiotics to treat MRSA
| Drug | Adult dose |
| Vancomycin | 15 to 20 mg/kg/dose every 8 to 12 hours, not to exceed 2 g per dose |
| Daptomycin | |
| Skin and soft tissue infection | 4 mg/kg IV once daily |
| Bacteremia | 6 mg/kg IV once daily |
| Linezolid | 600 mg IV (or orally) twice daily |
| Ceftaroline | 600 mg IV every 12 hours |
| Dalbavancin (for skin and soft tissue infection) | Single-dose regimen: 1500 mg once
Two-dose regimen: initial dose 1000 mg, followed by 500 mg dose one week later |
| Oritavancin (for skin and soft tissue infection) | 1200 mg IV as a single dose |
| Tedizolid (for skin and soft tissue infection) | 200 mg IV (or orally) once daily |
| Telavancin | 10 mg/kg once daily |
“Clindamycin is FDA approved for the treatment of MRSA infections and is appropriate in infants. Trimethoprim/sulfamethoxazole is not FDA approved for MRSA infections, but most strains of the community-acquired bacteria are susceptible to this combination. It is safe to use in infants over the age of 2 months, but is not available as an intravenous preparation and may be inadequate if the infection turns out to be streptococcal.”