Treating MRSA skin and soft-tissue infection

A collection of pus is a walled-off space that antibiotics penetrate poorly. For a fluctuant abscess or boil, a clinician anaesthetises the skin, makes a small incision and drains the cavity. Pain usually improves within 24–48 hours. The drained material is sent for culture, which confirms MRSA and shows which antibiotics the strain is susceptible to.

Simple, well-drained abscesses in healthy people often need nothing more. See the MRSA boil page for what the lesion looks like beforehand.

• Surrounding cellulitis, or redness spreading beyond the lesion
• Fever, chills or any systemic upset
• Abscess larger than about 2 cm, or several lesions at once
• Infection on the face, hand or genital area, or over an implant
• Diabetes, immunosuppression, very young or frail patients
• No improvement 48 hours after drainage

For severe cellulitis needing admission, treatment starts intravenously with vancomycin, daptomycin or a single dose of dalbavancin or oritavancin.

Keep the wound covered with a clean dry dressing until it stops draining, wash hands after every dressing change, bag soiled dressings before disposal, and do not share towels, razors or bedding. Warm compresses can help a small lesion point and drain. Detailed household measures are on the at home and family page.

Repeated boils usually reflect persistent colonisation rather than antibiotic failure. The standard approach is five days of nasal mupirocin twice daily plus chlorhexidine body washing, often repeated monthly and extended to household contacts — see decolonisation and why MRSA keeps coming back.