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Medical Author:

Charles Patrick Davis, MD, PhD

Charles Patrick Davis, MD, PhD

Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Antibiotic therapy is still the mainstay of medical care for MRSA, but antibiotic therapy is complicated by MRSA's antibiotic resistance. Consequently, laboratory determination of MRSA antibiotic resistance and susceptibility is important in establishing effective antibiotic treatment. Definitive antibiotic therapy depends on using those antibiotics shown in microbiological tests (using Kirby-Bauer antibiotic discs on agar plates [see above diagnosis section]) to effectively reduce and stop MRSA growth. Once the antibiotic sensitivities of the patient sample are determined, the patient can be treated appropriately. Unfortunately, these tests take time (usually several days) before results are available.

If a patient has been diagnosed with a MRSA infection, as with all antibiotic therapies, it is important for them to take all antibiotics as directed; do not stop the antibiotic even if the symptoms seem to resolve before the prescribed dose is finished. Early stoppage of antibiotics can allow MRSA to survive and develop further antibiotic resistance. If initial medical care (especially antibiotic therapy) does not help to reduce or eliminate the symptoms, do not wait until the symptoms get worse; go back to a health care provider for further care.

The majority of serious MRSA infections are treated with two or more intravenous antibiotics that, in combination, often still are effective against MRSA (for example, vancomycin, linezolid [Zyvox], rifampin [Rifadin], sulfamethoxazole-trimethoprim [Bactrim, Bactrim DS, Septra, Septra DS, SMZ-TMP DS, Sulfatrim Pediatric], and others). Minor skin infections, however, may respond well to mupirocin (Bactroban). The earlier the appropriate diagnosis and therapy is instituted for MRSA, the better the prognosis. The CDC suggests that a number of different antibiotic regimens may work to help patients based on the type of infection, its severity, and the state of the patient (child, adult, pregnant, or compromised with health problems); the CDC recommends following guidelines published by the Infectious Diseases Society of America in 2011.

Drainage of pus is the main surgical treatment of MRSA infections. Items that can serve as sources of infection (tampons, intravenous lines) should be removed. Other foreign bodies present that are likely sources of infection (for example, artificial grafts, artificial heart valves, or pacemakers) may need to be removed if appropriate antibiotic therapy is unsuccessful. Other areas that can harbor MRSA and may need surgical interventions are joint infections, postoperative abscesses, and infection of the bone (osteomyelitis). This is not an all-inclusive list; any site that continues to harbor and seed MRSA into the patient and is not adequately treated by antibiotic therapy should be considered for surgical intervention. Drainage of pus needs to be followed by appropriate antibiotic therapy as discussed above.

Unfortunately, patients can still die from MRSA infection, even with appropriate antibiotic therapy, if the infection overwhelms the patient's defense mechanisms (immune system).

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