MRSA Impetigo Rx

Q: 83 years old male with several previous hospitalizations with methicillin-resistant Staphylococcus aureus (ΜRЅA) sepsis is transferred from a nursing home to ICU again with MRSA sepsis. Impetigo is noted on dermal exam. Which of the following groups of antibiotics may NOT work? - select one

A) trimethoprim-sulfamethoxazole

B) clindamycin

C) doxycycline

D) fluoroquinolones 

Answer: D

Patients with suspected ΜRЅA impetigo can be treated with trimethoprim-sulfamethoxazole, clindamycin, or doxycycline while waiting for sensitivity results.

ΜRЅA resistance to fluoroquinolones is very high, and usually, it does not work in this clinical situation.

#ID

References:

1. Hartman-Adams H, Banvard C, Juckett G. Impetigo: diagnosis and treatment. Am Fam Physician. 2014 Aug 15;90(4):229-35. PMID: 25250996.

2. Vendrik KEW, Kuijper EJ, Dimmendaal M, Silvis W, Denie-Verhaegh E, de Boer A, Postma B, Schoffelen AF, Ruijs WLM, Koene FMHPA, Petrignani M, Hooiveld M, Witteveen S, Schouls LM, Notermans DW; MRSA consortium. An unusual outbreak in the Netherlands: community-onset impetigo caused by a meticillin-resistant Staphylococcus aureus with additional resistance to fusidic acid, June 2018 to January 2020. Euro Surveill. 2022 Dec;27(49):2200245. doi: 10.2807/1560-7917.ES.2022.27.49.2200245. PMID: 36695440; PMCID: PMC9732922.

3. Nardi NM, Schaefer TJ. Impetigo. [Updated 2023 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430974/