Reference · Treatment

How MRSA is treated

MRSA treatment depends on where the infection is, how severe it is, and whether the strain is community- or hospital-acquired. Draining or removing the source of infection matters as much as the antibiotic. Start with the section that matches the infection.

Choose the right section

Skin & soft-tissue infection

Incision and drainage first, when antibiotics are added, which oral drugs work and how long treatment lasts.

Invasive wound infection

Surgical and traumatic wounds, debridement, implants and bone, and switching from the drip to tablets.

Bloodstream infection

Bacteraemia and endocarditis: source control, treatment duration, persistent infection — and the full MRSA drug list.

Decolonisation

Nasal mupirocin and chlorhexidine washes to clear carriage and stop repeat infection.

The principles behind every MRSA decision

MRSA carries the mecA gene, which produces an altered penicillin-binding protein (PBP2a). That single change makes the organism resistant to almost the entire beta-lactam family — methicillin, flucloxacillin, most cephalosporins and the common penicillins. Treatment therefore relies on other classes: glycopeptides, lipopeptides, oxazolidinones, tetracyclines, sulfonamide combinations and one MRSA-active cephalosporin.

Three questions drive the choice. Where is it? Skin infection can be treated with tablets; bloodstream, lung and bone infection needs intravenous therapy. How sick is the patient? Fever, low blood pressure or confusion move treatment to hospital immediately. Is there something to drain or remove? An abscess, an infected line, or a prosthesis will keep the infection going no matter which antibiotic is used.

Drugs used against MRSA

Every drug below has its own page covering how it works, dosing and monitoring, how it was developed, side effects, and what else it is used for. The full comparison table sits on the bloodstream infection page.

Vancomycin

The long-standing first-line intravenous antibiotic for serious MRSA infection, including bloodstream infection and endocarditis.

Daptomycin

A rapidly bactericidal lipopeptide used for MRSA bloodstream infection, right-sided endocarditis and complicated skin infection — but never for pneumonia.

Linezolid

An oxazolidinone with complete oral absorption and excellent lung penetration, widely used for MRSA pneumonia and refractory skin infection.

Trimethoprim-sulfamethoxazole

A cheap, widely available oral combination that is a first-line choice for community-acquired MRSA skin infection and abscess.

Doxycycline

A tetracycline taken by mouth that reliably covers community-acquired MRSA skin infection and is well suited to outpatient treatment.

Clindamycin

A lincosamide that suppresses staphylococcal toxin production, useful in paediatric MRSA and in necrotising soft-tissue infection.

Ceftaroline

The cephalosporin that binds PBP2a — a beta-lactam that actually works against MRSA, often used as salvage therapy in persistent bacteraemia.

Dalbavancin

A long-acting lipoglycopeptide that can treat MRSA skin infection with a single infusion, avoiding a hospital stay or a long line.

Oritavancin

A single-dose lipoglycopeptide for acute MRSA skin infection, with three separate mechanisms of killing.

Teicoplanin

A once-daily glycopeptide used widely outside the United States as a more convenient, less nephrotoxic alternative to vancomycin.

Tedizolid

A second-generation oxazolidinone: once daily, a shorter course than linezolid, and less effect on blood counts.

Rifampin (rifampicin)

Never used alone for MRSA, but added to other agents for infection on prosthetic material and bone because it kills bacteria inside biofilm.