Antibiotic Treatment

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).

Decolonisation regimen

Adults only, discuss with Infection Control Provider before using these preparations on children

4% Chlorhexidine

• Daily for 5 days all over body. Also apply as a shampoo.
  • Apply directly to skin as a liquid soap on a sponge or flannel and lather well prior to rinsing, use a clean disposable flannel each day.
  • Pay particular attention to groin and axilla
  • Do not dilute in bath water
  • Toiletries can be used after rinsing
  • Change bed clothes and night clothes daily, after washing, for the five days

Nasal antibiotic

• Apply three times daily for 5 days
  • Place a pea size amount of ointment on the squamous portion of each nostril and massage gently upwards

Follow up screening following decolonisation therapy

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:

• Nose
• Throat
• Perineum/groin
• Lesions or sites of abnormal skin including ulceration, eczema, pressure areas, and sites of insertion of intravascular cannulas, suprapubic catheters, tracheostomies, drains or Percutaneous Endoscopic Gastrostomies. The umbilicus should also be sampled in neonates
• Sputum if a productive cough
• Urine if a urethral catheter in situ
• A vaginal swab should normally only be taken if there is a vaginal operative lesion or from a mother of a colonised neonate.

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.