Antibiotics Not Always Needed for MRSA

Jan. 5, 2011 -- The superbug staph infection, MRSA, has become a global health threat for adults and children, but antibiotics aren't needed to treat all cases, according to new guidelines released by the Infectious Diseases Society of America (IDSA).

MRSA, or methicillin-resistant Staphyloccus aureus, is a bacterium that is hard to kill with the most commonly used antibiotics. The superbug is responsible for about 60% of all skin infections seen in hospital emergency rooms. If the bacteria invade broken skin, life-threatening lung, blood, bone, joint, or nervous system infections can result.

The antibiotic vancomycin is often first prescribed for severe MRSA infections. However, there has been debate about whether or not antibiotics are necessary or helpful for minor MRSA skin infections, such as a simple boil. Overuse of antibiotics in general has fueled the growing threat of antibiotic resistance.

The IDSA's new guidelines provide the first authoritative MRSA treatment recommendations for doctors. A 13-panel board comprised of members of the Infectious Diseases Society, the American College of Emergency Physicians, and the American Academy of Pediatrics reviewed and endorsed the guidelines.

The guidelines address the treatment of:

• MRSA skin and soft tissue infections in non-hospitalized patients
• MRSA skin infections that keep coming back or do not get better with antibiotic treatment
• MRSA infections that have spread to the lungs, bones, joints, blood, or heart
• Newborns infected with the superbug

The 38-page document also provides specific recommendations regarding the use of vancomycin and alternative antibiotics, and calls for the development of new and better medicines for treating MRSA. It does not address MRSA surveillance or prevention. The CDC says proper hand-washing and good hygiene are the best defense against MRSA infections.

Key Recommendations

According to the new guidelines, a simple skin abscess or boil from MRSA can usually be successfully treated by draining the site. No antibiotics may be needed in some cases.

In general, antibiotics should be considered for skin and soft-tissue infections if the patient has:

• severe or extensive disease, such as several MRSA skin infections at one time
• an abscess in an area that is hard to drain, such as on the face or genitalia
• an abscess that does not get better with incision and drainage
• signs of a life-threatening skin condition called cellulitis
• a weakened immune system because of another disease or drug treatment
• another medical condition that affects the entire body (systemic illness)

Antibiotic ointments are recommended for children with minor skin infections such as impetigo or skin infections associated with other skin conditions such as eczema.

Guidelines Not Mandatory

The guidelines are not considered mandatory and are not meant to be a substitute for your doctor's judgment. Instead, they provide insight for doctors to make the most appropriate treatment decisions based on each individual person.

"MRSA has become a huge public health problem and physicians often struggle with how to treat it," said Catherine Liu, MD, author of the guidelines and assistant clinical professor in the Division of Infectious Diseases, University of California, San Francisco. "The guidelines establish a framework to help physicians determine how to evaluate and treat uncomplicated as well as invasive infections. It's designed to be a living document, meaning the recommendations will evolve as new information and antibiotics become available."

The guidelines will be published in the Feb. 1 issue of Clinical Infectious Diseases.