All infections due to MRSA should be managed on an individual basis in discussion with Consultant Microbiologist or ID Physician and in accordance with individual sensitivity patterns.
For decolonisation regimes and further management of colonisation due to MRSA please follow the Procedure Management of Staphylococcus Aureus (MSSA/MRSA).
The aim is not to eradicate, but to reduce the MRSA bio-burden to such a level that the cycle of colonisation to infection is prevented for the individual patient. Bio-burden reduction will also reduce patient-to-patient transmission of MRSA. The use of this regime without the removal of IV lines or urinary catheters will reduce the success. MRSA decolonisation prescription stickers are available on all wards.
Bathe daily for 5 days. Moisten skin and apply to all areas with special attention to the axillae, groins and perineum, and any other areas with known carriage. Use as a shampoo twice in the five days period (day 1 and 2).
Use Prontoderm as per (Elective Surgery)
Prontoderm pack as per (Elective Surgery).
Body system |
Treatment Choice |
Comments |
Acute exacerbation of COPD (Non-pneumonic LRTI) |
Doxycycline 100mg PO q12h Or Clindamycin PO 600mg q6h plus |
Treat according to culture and sensitivity Clindamycin should only be used if the strain is susceptible to erythromycin |
Bronchiectasis |
Doxycycline 100mg PO q12h Or Clindamycin PO 600mg q6h plus |
Treat according to culture and sensitivity Clindamycin should only be used if the strain is susceptible to erythromycin Rifampicin and sodium fusidate should NOT be used as monotherapy but always in combination with another anti-MRSA agent. Discuss with Consultant Microbiologist before using regimes containing rifampicin |
Pneumonia |
Vancomycin IV (dosed as per trust vancomycin guideline) +/- Sodium fusidate PO 500mg q8h or Rifampicin PO 600mg q12h |
Consider stepping down to oral therapy once patient is clinically stable. |
Body system - MRSA |
Treatment Choice |
Comments |
Urinary tract infections |
Doxycycline PO 200mg q12h Or Trimethoprim PO 200mg q12h Or Nitrofurantoin PO 100mg q6h (for cystitis only) |
Lack of data on the efficacy of vancomycin. Vancomycin NOT recommended due to lack of data on efficacy, cost, toxicity and availability of other oral agents |
Body system |
Treatment Choice |
Comments |
Superficial eye infections |
Fusidic acid 1% MR eye drops One drop to be instilled into the affected eye (s) twice a day. Continue treatment for 2 days after symptoms have resolved |
Discuss alternative treatment options with microbiology if failure to respond to treatment or resistance to fusidic acid. |
Deep eye and CNS infections |
Discuss with Ophthalmologist or Consultant Microbiologist for advice |
|
Body system |
Treatment Choice |
Comments |
Uncomplicated skin and soft tissue infections |
Doxycycline PO 100mg q12h |
Not suitable for severe infections where there is a high risk of bacteraemia or endocarditis |
Severe skin and soft tissue infections where there is a high risk of bacteraemia or endocarditis |
Vancomycin IV (dosed as per trust vancomycin guideline) |
|
Severe skin and soft tissue infections that have failed therapy with single active agents |
Vancomycin IV (dosed as per trust vancomycin guideline) Or Doxycycline PO 100mg q12h plus sodium fusidate PO 500mg q8h Or Doxycycline PO 100mg q12h plus rifampicin PO 600mg q12h
|
Treat according to culture and sensitivity results |
Body system |
Treatment Choice |
Comments |
IV infusion sites infections Line removal is the mainstay of treatment Duration of therapy is 2 weeks |
Remove the line Trimethoprim PO 200mg q12h plus rifampicin PO 600mg q12h Or Trimethoprim PO 200mg q12h plus Sodium fusidate PO 500mg q8h Or Vancomycin IV (dosed as per trust vancomycin guideline) |
If severe infection e.g. pus, cellulitis or tunnel infection are present;urgent line removal |
Body system |
Treatment Choice |
Comments |
Prosthetic Joint infection |
Vancomycin IV (dosed as per trust vancomycin guideline) plus rifampicin PO 600mg q12h Or Vancomycin IV (dosed as per trust vancomycin guideline) plus sodium fusidate PO 500mg q8h |
Prolonged treatment often required |
Bone and Joint Infections |
Vancomycin IV (dosed as per trust vancomycin guideline) plus rifampicin PO 600mg q12h Or Vancomycin IV (dosed as per trust vancomycin guideline) plus sodium fusidate PO 500mg q8h |
Prolonged treatment often required |