The IDSA has issued MRSA treatment guidelines. Although the full document is lengthy, here are some of the highlights: Vancomycin is still first line treatment for most patients with invasive MRSA infections. Second line agents include linezolid, daptomycin (but not in pneumonia), and clindamycin. For CA-MRSA skin / soft tissue infections, those with an abscess should be drained (and do not necessarily need antibiotics) while those with purulent cellulitis should be treated with a CA-MRSA agent (TMP-SMX, clindamycin, tetracycline, linezolid). Vancomycin dosing should be 15-20mg/kg for most patients, with trough level goals of 15-20. For patients with an MIC>2, close clinical follow up is recommended, with switching to another agent for treatment failure (Full guidelines).
Dr. Scheurer is a clinical hospitalist and the Medical Director of Quality and Safety at the Medical University of South Carolina in Charleston, South Carolina, and is Assistant Professor of Medicine. She is a graduate of the University of Tennessee College of Medicine, completed her residency at Duke University, and completed her Masters in Clinical Research at the Medical University of South Carolina. She also serves as the Web Editor and Physician Advisor for the Society of Hospital Medicine.