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Methicillin Resistant S. aureus (MRSA)

In This Section

Decolonisation protocol

Surgical prophylaxis

MRSA soft tissue infection

Bacteraemia

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Decolonisation protocol

Refer to MRSA decolonisation guideline in the Multidrug Resistant Organisms (MDRO): Guidelines for control, and in Hospital HealthPathways.

mupirocin 2% ointment

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Apply to nose (both sides) twice a day with clean cotton buds for 7 days

OR, if mupirocin resistance:

povidone-iodine 10% ointment

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Apply to nose (both sides) twice a day with clean cotton buds for 7 days

AND EITHER

chlorhexidine gluconate 4% solution

(first-line)

Use once a day as a body wash for showering and twice a week for hair washing for 7 days

OR, for patients intolerant of chlorhexidine and those with sensitive or fragile skin:

octenidine 0.3% wash lotion

(second-line)

Use once a day as a body wash for showering and twice a week for hair washing for 7 days

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Surgical prophylaxis

Surgical prophylaxis if MRSA colonised, or previously MRSA colonised and current status unknown.

vancomycin

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IV 1 g (< 70 kg), 1.5 g (70 – 100 kg) or 2 g (>100 kg). See surgical antimicrobial prophylaxis.

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MRSA soft tissue infection

trimethoprim+sulfamethoxazole

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PO 160 mg/800 mg to 320 mg/1600 mg twice a day

OR

clindamycin

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PO 450 mg three times a day or IV 600 mg every eight hours

Co-infection with group A streptococcus

Use clindamycin alone if susceptible, or add penicillin to above antimicrobials:

benzylpenicillin

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(Penicillin G)

IV 1.8 g (3 megaunits) every six hours

followed by early switch to

phenoxymethylpenicillin

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(Penicillin V)

PO 500 mg four times a day

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Bacteraemia

Suspected S. aureus bacteraemia (MRSA status unknown)

flucloxacillin

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IV 2 g every six hours

Mild penicillin allergy

cefazolin

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IV 2 g every eight hours

Severe penicillin allergy

vancomycin

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See dosing guidelines (use high doses)

Suspected S. aureus bacteraemia with risk factors for MRSA colonisation

ADD vancomycin to the above regimens (flucloxacillin or cefazolin) until culture and susceptibility results are available:

vancomycin

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See dosing guidelines (use high doses)

Confirmed MRSA bacteraemia

vancomycin

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See dosing guidelines (use high doses)

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Topic Code: 132653