Evidence based approach to the treatment of community-associated methicillin-resistant Staphylococcus aureus

Evidence based approach to the treatment of community-associated methicillin-resistant Staphylococcus aureus William J Peppard1, Anne Daniels1, Lynne Fehrenbacher2, Jamie Winner31Froedtert Hospital Milwaukee, Wisconsin, USA; 2Aurora St Luke’s Medical Center Milwaukee, Wisconsin, USA; 3Clement J Zablocki VA Medical Center, Milwaukee, Wisconsin, USAAbstract: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections have increased dramatically over the last two decades. The types of infections can range from complicated skin and skin structure infections (cSSSI) to pneumonia and endocarditis. Oral antimicrobial therapy, such as trimethoprim-sulfamethoxazole, clindamycin, long-acting tetracyclines, or linezolid may provide enhanced benefit to those with uncomplicated cutaneous lesions when used in conjunction with incision and drainage in an outpatient setting. However, resistance, susceptibilities, patient-specific circumstances, and adverse effects can impact a healthcare professional’s choice of antibiotics. In patients with complicated infections requiring hospitalization or parenteral treatment, vancomycin remains the drug of choice, even though increased resistance and decreased efficacy have crept into clinical practice. Linezolid, quinupristin/dalfopristin, daptomycin, and tigecycline are alternative intravenous agents for the treatment of CA-MRSA. Investigational agents such as dalbavancin, telavancin, oritivancin, iclaprim, ceftobiprole, ceftaroline, and others may expand our therapeutic armamentarium for the treatment of infections caused by CA-MRSA in the future.Keywords: community-associated methicillin-resistant Staphylococcus aureus, CA-MRSA, complicated skin and skin structure infections, cSSSI, Panton-Valentine leukocidin, PVL, in vitro activity