Oral antibiotic treatment for methicillin-resistant Staphylococcus aureus skin and soft tissue infections: review of the literature.

BACKGROUND: The emergence of methicillin-resistant Staphylococcus aureus (MRSA) as a cause of hospital- and community-associated infection has been reported worldwide and has become an increasing health care problem. Treatment options for MRSA infection are limited, complicated and expensive. Oral antibiotics have been used in the outpatient setting for less severe MRSA infections such as skin and soft tissue infections (SSTIs), but their efficacy has not been well studied.

METHODS: We reviewed the literature and Internet information sources as well as recent abstracts for factors relevant to the in-vitro and in-vivo activity and adverse effects of oral antibiotics of possible value in treating MRSA SSTI.

RESULTS: Most of MRSA isolates are still susceptible to linezolid, TMP-SMX, and the tetracyclines but less susceptible to the quinolones, clindamycin, and erythromycin. Only the quinolones have bactericidal activity, which may be a relevant factor if there is bacteremia. In-vivo studies indicate a high clinical cure rate with linezolid, TMP-SMX, doxycycline and minocycline. Adverse effects are different among the drugs and are a significant factor. Antibiotics with once-daily dosing such as the quinolones have advantage in regard to compliance. Linezolid has the highest daily cost of treatment whereas the cost of the tetracyclines, erythromycin, and TMP-SMX is much lower.

CONCLUSION: The antibiotics available for MRSA SSTI vary widely in chances of resistance, activity, adverse effects, and cost. More clinical studies of clinical efficacy are needed, especially with comparative trials. Selection of the most appropriate antibiotic will depend upon local antibiotic resistance, type of infection, potential adverse effects, and cost for the individual.