Strep coverage with potential MRSA?

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I commonly use trimethoprim/sulfamethoxazole (Septra) (TMP/SMX) or doxycycline to treat infections that could be attributable to methicillin-resistant Staphylococcus aureus (MRSA). Should an additional antibiotic be considered for strep coverage? – BRUCE BRASWELL, PA-C, Vandalia, Ill.

I assume you are referring to uncomplicated skin or soft-tissue infections and not invasive or complicated infections. An uncomplicated abscess without associated cellulitis is treated with surgical drainage and local wound care and does not require routine administration of antibiotics. Empiric antibiotic therapy for cellulitis associated with an abscess or purulent drainage should be directed at community-acquired methicillin-resistant S. aureus (CA-MRSA) and methicillin-sensitive S. aureus (MSSA). Doxycyline or TMP/SMX provides excellent coverage against both organisms. Cellulitis without an associated purulent lesion should be treated with antibiotics directed at CA-MRSA, MSSA, and group A b-hemolytic streptococci. An additional antibiotic (e.g., cephalexin) or monotherapy with clindamycin is also administered.—Jo Ann Deasy, PA-C, MPH
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