Pharmacological agents for soft tissue and bone infected with MRSA: Which agent and for how long?

Methicillin-resistant Staphylococcus aureus (MRSA) infections cause an important number of soft tissue and bone infections, although exact rates vary across different countries and institutions. The length of antibiotic treatment required depends upon the severity of infection and pre-existing co-morbidities. Monitoring response to treatment is important to ensure cure of infection whilst preventing excessive antibiotic use. Debridement and drainage, in addition to prosthesis removal, may be necessary.Numerous antibiotics are effective at treating soft tissue and bone infected with MRSA. Oral antibiotics, such as clindamycin, doxycycline and linezolid, generally offer good bioavailability and tissue penetration. They are separated largely by side effect profile and drug interactions, which should be considered carefully prior to use. There are also several agents only available in the intravenous (IV) form, for example glycopeptides, daptomycin and tigecycline. These are normally reserved for the treatment of severe infections. Whilst tissue penetration is variable within this group, it is the adverse events linked with each antibiotic that are most effective in determining the preferred agent.