MRSA un-complicated soft tissue infection - Management of Infection Guidance for Primary Care |
Publication: 30/09/2010 |
Next review: 01/02/2028 |
Clinical Guideline |
CURRENT |
ID: 2258 |
Approved By: |
Copyright© Leeds Teaching Hospitals NHS Trust 2023 |
This Clinical Guideline is intended for use by healthcare professionals within Leeds unless otherwise stated. |
MRSA uncomplicated skin and soft tissue infection treatment in Primary Care in adults | ||
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Skin and soft tissue infections (SSTI) are the most common presentation of MRSA (meticillin-resistant Staph. Aureus) infection, although it can also cause severe, invasive disease. This guideline is for the treatment of uncomplicated skin and soft tissue infection (eg cellulitis, erysipelas, abscess) with MRSA. Staphylococcus aureus, including MRSA, is one of the most common pathogens that cause cellulitis/abscesses. MRSA is resistant to penicillin-related antibiotics such as flucloxacillin and most cephalosporins and may be resistant to other antibiotic classes. Lack of response to empiric antibiotics may be due to MRSA. Note:
Antibiotics Use sensitivities on report to guide treatment; If no response to treatment, seek advice from Microbiology. If active infection and patient has MRSA risk factors (see below), and admission not warranted:
Risk factors for MRSA infection include:
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Preferred Option |
Alternative Option |
Notes |
Doxycycline initially 200 mg daily for 1 dose, then maintenance 100 mg once daily PO 5 days (may be extended up to 14 days depending on clinical response). |
Co-trimoxazole (contains trimethoprim and sulfamethoxazole) (trimethoprim/sulfamethoxazole) 960mg twice daily PO 5 days (may be extended up to 14 days depending on clinical response) (see BNFc for dosing in children >6 weeks old) Or |
Check the MRSA is susceptible - see culture sensitivity report. |
Note: Doses are oral and for adults unless otherwise stated. Please refer to BNF for further information.
Notes:
Colonisation
Approximately 1/3 people carry Staphylococcus aureus on their skin/nasal passages. About 10% of these will be MRSA. Antibiotics are not indicated for MRSA colonisation. A topical decolonisation regime may be indicated for MRSA colonisation in some circumstances; decolonisation should be administered according to local screening and decolonisation protocols (d/w community Infection Prevention & Control team or Microbiologist).
Microbiological Samples
Identifying the infecting pathogen may not be necessary for treating uncomplicated skin infections but cultures may be helpful in patients with recurrent abscesses or where there is lack of response to empiric antibiotics. A microbiological diagnosis of cellulitis is often not possible. If there is no wound/skin break, pus or discharge to swab, a skin swab is unlikely to identify the microbiological cause of cellulitis. Send a swab for microbiological culture and sensitivity if there is a wound or penetrating injury, pus or discharge, if there has been exposure to a water-borne organism, if the infection was acquired outside the UK, if there has been no response to empirical treatment or for recurrent infections.
Recurrent skin infections may be due to Panton-Valentine Leukocidin - Staphylococcus aureus (PVL-SA). Panton-Valentine Leukocidin (PVL) is a toxin that destroys white blood cells and is excreted by some strains of Staphyloccus aureus including both Meticillin Resistant (MRSA) and Meticillin Sensitive Staphyloccus aureus (MSSA). PVL has been
strongly associated epidemiologically with virulent, transmissible strains of S.aureus, including community-associated (CA) MRSA. Consider testing for PVL-SA if there is a history of recurrent SSTI (the request should give relevant history; staphylococcus aureus isolated from samples may be referred to the Reference lab for PVL detection by WGS). Decolonization may be indicated for patients with PVL-SA skin infections and their family members and should be discussed with community Infection Prevention & Control team or with the Microbiologist.
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Provenance
Record: | 2258 |
Objective: |
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Clinical condition: | MRSA un-complicated soft tissue infection |
Target patient group: | |
Target professional group(s): | Primary Care Doctors Pharmacists |
Adapted from: |
Evidence base
Daum RS, Miller LG, Immergluck L, et al. A Placebo-Controlled Trial of Antibiotics for Smaller Skin Abscesses. The New England journal of medicine 2017; 376(26): 2545-55.
Fahimi J, Singh A, Frazee BW. The role of adjunctive antibiotics in the treatment of skin and soft tissue abscesses: a systematic review and meta-analysis. CJEM 2015; 17(4): 420-32.
Talan et al., Trimethoprim-sulfamethoxazole versus placebo for uncomplicated skin abscess. N Engl J Med2016;374:823-32.doi:doi:10.1056/NEJMoa1507476.pmid:26962903
Wang W et al. Antibiotics for uncomplicated skin abscesses: systematic review and network meta-analysis. BMJ Open 2018;8:e020991
Document history
LHP version 1.0
Related information
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