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Methicillin Resistant Staphylococcus aureus (MRSA) is resistant to all penicillins and cephalosporins. It can be present on the skin or in the throat of healthy people without causing any problems. If the patient is well without signs and symptoms of acute infection then antibiotic therapy is not required. Where patients who are screened are found to be colonised with MRSA a five day regimen may be required to reduce MRSA levels and decrease the chance of infection and spread.
Important: For patients who are undergoing elective surgical procedures it is the responsibility of the centre carrying out that procedure to screen patients as part of the pre-admission assessment and prescribe the suppression treatment if necessary. GPs should not routinely be expected to screen patients or prescribe suppression and the programme detailed in this appendix is included for information only.
Screening isolates are not tested for susceptibilities so ensure adequate sample labeling.
Route of antibiotic should follow the same principles as for sensitive staphylococcal infections.
Oral doxycycline 100mg every 12 hours, consider additional rifampicin 300mg every 12 hours, or if UTI oral trimethoprim 200mg every 12 hours
Intravenous vancomycin (dose according to weight and renal function), or once daily teicoplanin with oral Rifampicin (300mg every 12 hours), or Fusidic Acid (500mg every 8 hours).
Adults only, discuss with Infection Control Provider before using these preparations on children
A full set of post-eradication swabs should be taken 72 hours after completing the course. The following sites should be sampled when colonisation is being investigated:
If this screen is negative, then two further swabs should be taken at weekly intervals. Once three negative screens have been obtained, colonisation can be considered to have has been cleared or reduced to a safe level. If any of these screens are positive, a further round of eradication therapy should normally be prescribed and the process repeated. If this fails to eradicate colonisation, further rounds of treatment are unlikely to be successful. However, further courses may be indicated in certain circumstances as decided by the Microbiologist and Infection Prevention and Control team. Decolonisation therapy is often ineffective and success is greatly reduced in the presence of pre-existing ulcers, wound or skin conditions.