When should you suspect community-acquired MRSA? How should you treat it?

Avoid fluoroquinolones

MRSA isolates demonstrate a high resistance to fluoroquinolones, so this class of drugs isn’t recommended.³

Recommendations

The Centers for Disease Control and Prevention (CDC) recommends the following treatment for CA-MRSA:

• drain all abscesses; incision and drainage alone suffices for immunocompetent patients
• for other patients, consider adjunct treatment with clindamycin, trim-ethoprim and sulfamethoxazole, tetracyclines, or linezolid.

The CDC also recommends consulting an infectious disease specialist before using linezolid and avoiding fluoroquinolone and macrolide antibiotics because resistance develops rapidly.⁸ Rifampin can be used in combination with other standard treatments.⁸

The CDC doesn’t recommend treating nonpurulent skin infections with CA-MRSA-specific antibiotics. These infections are generally caused by Streptococcus pyogenes and remain sensitive to β-lactam antibiotics. When the community prevalence of CA-MRSA is low, a β-lactam antibiotic can be used with close follow-up.⁸

The Infectious Diseases Society of America recommends incision and drainage for abscesses and treatment with CA-MRSA-specific antibiotics for purulent skin infections.⁹