# Community-Acquired MRSA Skin and Soft Tissue Infection - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - Sources: Egyptian National Drug Formulary - Antimicrobial 2023 · IDSA Guidelines for the Treatment of Methicillin-Resistant Staphylococcus Aureus Infections 2011 · Egyptian National Drug Formulary (Antimicrobial Chapter 2023) · IDSA Clinical Practice Guidelines for the Treatment of MRSA Infections in Adults and Children, 2011 - Verified date: 2026-08 ## Verified against - Egyptian National Drug Formulary - Antimicrobial 2023 - IDSA Guidelines for the Treatment of Methicillin-Resistant Staphylococcus Aureus Infections 2011 - IDSA Clinical Practice Guidelines for the Treatment of MRSA Infections in Adults and Children, 2011 ## Treatment metadata - Sulphamethoxazole + Trimethoprim — 800 mg — oral.solid - Doxycycline — 100 mg — oral.solid - Clindamycin — 300 mg — oral.solid - Linezolid — 600 mg — oral.solid ## Complete treatment card ```text COMMUNITY-ACQUIRED MRSA SKIN AND SOFT TISSUE INFECTION Sources: Egyptian National Drug Formulary - Antimicrobial 2023 · IDSA Guidelines for the Treatment of Methicillin-Resistant Staphylococcus Aureus Infections 2011 · Egyptian National Drug Formulary (Antimicrobial Chapter 2023) · IDSA Clinical Practice Guidelines for the Treatment of MRSA Infections in Adults and Children, 2011 Review status: REVIEWED against 3 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (5) - Skin and the tissue under it are the usual targets; deeper infection follows as bacteraemia, bone infection, meningitis, pneumonia, lung abscess or empyema [abscess · empyema] - Community MRSA is the leading organism behind skin and soft tissue infection, including cellulitis, necrotising fasciitis and diabetic foot ulcers [cellulitis] - These infections are more invasive than non-MRSA ones and often resistant to several drugs, so they recur, need admission, and kill more often - It can reach any organ, and it also causes illness through the toxins it makes - Red flag: MRSA endocarditis is deadlier than that caused by any other organism, and injecting drug users are especially at risk SIGNS - what you find (3) - Skin lesions from community MRSA are often blamed on a spider bite instead [skin lesions] - The typical picture is a painful red pustule, sometimes with fever, that the patient blames on a spider they never saw [fever · pustules] - Spiders that bite are extremely rare while MRSA skin infection is extremely common, so the odds favour the infection TESTS (7) - Suspicion in a patient with risk factors drives the workup, but waiting for confirmation must not delay empirical treatment - Send material from wherever the infection is: blood, sputum, urine, wound swabs, spinal fluid and surgical specimens - Gram-positive cocci in clusters on the Gram stain suggest Staphylococcus aureus - PCR identifies MRSA quickly while the culture is still growing - A nasal PCR screens for carriage rather than confirming infection, but a negative result is highly specific for excluding it - Two questions shape the assessment: does this patient have risk factors for MRSA, and if not, does the infection itself look like MRSA - Then ask whether it is confined to one site or has spread to others IF NOT THIS - what else fits (11) - Other infectious or inflammatory disorders of skin and soft tissue - Sepsis and septic shock - An abscess - Endocarditis - Acute gastroenteritis - Wound infection - Necrotising fasciitis, above all from beta-haemolytic streptococci - Acute arthritis or bursitis - Spondylitis - Infection of an implanted device or prosthesis - Pneumonia or meningitis Source StatPearls "Methicillin-Resistant Staphylococcus aureus" - disease-level clinical article Status traced to the source above 1. SULPHAMETHOXAZOLE + TRIMETHOPRIM [1st line] Adult 800/160 mg (1 double-strength tablet) to 1600/320 mg (2 double-strength tablets) orally twice daily x 5-10 days Peds 4-6 mg/kg/dose [child max 160 mg] (Dosed on trimethoprim component: 4-6 mg/kg per dose orally twice daily (max 160 mg trimethoprim/dose). Contraindicated in infants under 2 months.) 2 months and over: 4 to 6 mg trimethoprim/kg per dose by mouth twice daily, maximum 160 mg trimethoprim per dose. Contraindicated under 2 months. 3kg -> 12-18 mg/dose 4kg -> 16-24 mg/dose 5kg -> 20-30 mg/dose 6kg -> 24-36 mg/dose 7kg -> 28-42 mg/dose 8kg -> 32-48 mg/dose 9kg -> 36-54 mg/dose 10kg -> 40-60 mg/dose 11kg -> 44-66 mg/dose 12kg -> 48-72 mg/dose 13kg -> 52-78 mg/dose 14kg -> 56-84 mg/dose 15kg -> 60-90 mg/dose 16kg -> 64-96 mg/dose 17kg -> 68-102 mg/dose 18kg -> 72-108 mg/dose 19kg -> 76-114 mg/dose 20kg -> 80-120 mg/dose 21kg -> 84-126 mg/dose 22kg -> 88-132 mg/dose 23kg -> 92-138 mg/dose 24kg -> 96-144 mg/dose 25kg -> 100-150 mg/dose 26kg -> 104-156 mg/dose 27kg -> 108-160 mg/dose (upper capped) 28kg -> 112-160 mg/dose (upper capped) 29kg -> 116-160 mg/dose (upper capped) 30kg -> 120-160 mg/dose (upper capped) 31kg -> 124-160 mg/dose (upper capped) 32kg -> 128-160 mg/dose (upper capped) 33kg -> 132-160 mg/dose (upper capped) 34kg -> 136-160 mg/dose (upper capped) 35kg -> 140-160 mg/dose (upper capped) 36kg -> 144-160 mg/dose (upper capped) 37kg -> 148-160 mg/dose (upper capped) 38kg -> 152-160 mg/dose (upper capped) 39kg -> 156-160 mg/dose (upper capped) 40kg -> 160 mg/dose (capped) 41kg -> 160 mg/dose (capped) 42kg -> 160 mg/dose (capped) 43kg -> 160 mg/dose (capped) 44kg -> 160 mg/dose (capped) 45kg -> 160 mg/dose (capped) 46kg -> 160 mg/dose (capped) 47kg -> 160 mg/dose (capped) 48kg -> 160 mg/dose (capped) 49kg -> 160 mg/dose (capped) 50kg -> 160 mg/dose (capped) Choice Alternatives. Co-trimoxazole is named a highly effective oral first-line option for community-acquired MRSA and is the cheaper to start. Source IDSA Guidelines for the Treatment of Methicillin-Resistant Staphylococcus Aureus Infections 2011 Why Co-trimoxazole (Sulphamethoxazole + Trimethoprim) remains a highly effective oral first- line option for outpatient CA-MRSA skin infections in Egypt and is widely registered as oral tablets and suspension. Caution Incision and drainage is the definitive primary treatment for purulent skin abscesses; oral antibiotic therapy is adjunctive. Contraindicated in severe renal impairment, hyperkalemia, megaloblastic anemia, and third trimester of pregnancy. Advise patient to maintain adequate fluid intake to reduce the risk of crystalluria; monitor for severe cutaneous adverse reactions (Stevens-Johnson syndrome). Egypt CO-TRIMOXAZOLE 20 TABS. MUP 5.00 EGP (0.25/unit) -> ? strength differs COTRIL 400/80MG 20 TAB. EL NASR 38.00 EGP (1.90/unit) -> ? strength differs SEPTAZOLE FORTE 800/160MG 20 TABS. ALEXANDRIA 56.00 EGP (2.80/unit) -> ? strength differs SEPTRIN D.S 10 TABS. GLAXO SMITHKL... 28.00 EGP (2.80/unit) -> ? strength differs SEPTAZOLE 400/80MG 20*10 TABS. ALEXANDRIA 340.00 EGP (34.00/unit) -> ? strength differs SUTRIM 400/80MG 20*10 TAB. MEMPHIS 340.00 EGP (34.00/unit) -> ? strength differs CO-TRIMOXAZOLE 200/40MG SUSP. 120ML MUP 6.00 EGP -> ? strength differs, ? different route - not oral solid SUTRIM 200/40MG SUSP. 100ML MEMPHIS 18.50 EGP -> ? strength differs, ? different route - not oral solid 2. DOXYCYCLINE [1st line] Adult 100 mg orally twice daily x 5-10 days Peds 2.2 mg/kg/dose [child max 100 mg] (Children >= 8 years and weighing < 45 kg: 2.2 mg/kg per dose twice daily (max 100 mg/dose). Contraindicated in children under 8 years of age.) 8 years and over: Under 45 kg: 2.2 mg/kg per dose twice daily, maximum 100 mg per dose. Contraindicated under 8 years. 3kg -> 6.6 mg/dose 4kg -> 8.8 mg/dose 5kg -> 11 mg/dose 6kg -> 13.2 mg/dose 7kg -> 15.4 mg/dose 8kg -> 17.6 mg/dose 9kg -> 19.8 mg/dose 10kg -> 22 mg/dose 11kg -> 24.2 mg/dose 12kg -> 26.4 mg/dose 13kg -> 28.6 mg/dose 14kg -> 30.8 mg/dose 15kg -> 33 mg/dose 16kg -> 35.2 mg/dose 17kg -> 37.4 mg/dose 18kg -> 39.6 mg/dose 19kg -> 41.8 mg/dose 20kg -> 44 mg/dose 21kg -> 46.2 mg/dose 22kg -> 48.4 mg/dose 23kg -> 50.6 mg/dose 24kg -> 52.8 mg/dose 25kg -> 55 mg/dose 26kg -> 57.2 mg/dose 27kg -> 59.4 mg/dose 28kg -> 61.6 mg/dose 29kg -> 63.8 mg/dose 30kg -> 66 mg/dose 31kg -> 68.2 mg/dose 32kg -> 70.4 mg/dose 33kg -> 72.6 mg/dose 34kg -> 74.8 mg/dose 35kg -> 77 mg/dose 36kg -> 79.2 mg/dose 37kg -> 81.4 mg/dose 38kg -> 83.6 mg/dose 39kg -> 85.8 mg/dose 40kg -> 88 mg/dose 41kg -> 90.2 mg/dose 42kg -> 92.4 mg/dose 43kg -> 94.6 mg/dose 44kg -> 96.8 mg/dose 45kg -> 99 mg/dose 46kg -> 100 mg/dose (capped) 47kg -> 100 mg/dose (capped) 48kg -> 100 mg/dose (capped) 49kg -> 100 mg/dose (capped) 50kg -> 100 mg/dose (capped) Source Egyptian National Drug Formulary - Antimicrobial 2023 (doxycycline monograph): adult "100 to 200 mg/day in 1 to 2 divided doses" with 100 mg capsules; paediatric "2.2 mg/kg/dose every 12 hours, maximum dose: 100 mg/dose", with the formulary's own caution that use below 8 years be reserved for severe infections. The IDSA MRSA guideline is not held in this corpus. Why Tetracycline antibiotic active against community-acquired MRSA, an oral first-line option per IDSA guidance for skin and soft tissue infection. Caution Contraindicated in children under 8 years of age due to risk of permanent tooth enamel discoloration and bone growth retardation. Contraindicated during pregnancy and breastfeeding. Administer with a full glass of water while upright and remain standing or sitting for 30 minutes to prevent esophageal ulceration; advise sun protection. Egypt FARCODOXIN 100MG 10 CAPS. PHARCO 11.00 EGP (1.10/unit) DOXY M.R.100 MG 10 CAPS. ADWIA 12.00 EGP (1.20/unit) GRANUDOXY 100MG 10 F.C. TAB. GLOBAL NAPI P... 12.00 EGP (1.20/unit) DOXYDOX 100 MG 10 CAPS. EIPICO 23.00 EGP (2.30/unit) DOXYMYCIN 100 MG 10 CAPS. EL NILE. 30.00 EGP (3.00/unit) TABOCINE 100MG 10 CAPS. TABUK PHARMAC... 46.00 EGP (4.60/unit) VIBRAMYCIN 100MG 10 CAPS. PFIZER 65.00 EGP (6.50/unit) 3. CLINDAMYCIN [2nd line] Adult 300-450 mg orally three times daily x 5-10 days Peds 10-13 mg/kg/dose [child max 450 mg] (10-13 mg/kg per dose orally every 6-8 hours (max 40 mg/kg/day, and no single dose above 450 mg). This is the CA-MRSA dose and it is higher than clindamycin's dose for ordinary skin infection.) 3kg -> 30-39 mg/dose 4kg -> 40-52 mg/dose 5kg -> 50-65 mg/dose 6kg -> 60-78 mg/dose 7kg -> 70-91 mg/dose 8kg -> 80-104 mg/dose 9kg -> 90-117 mg/dose 10kg -> 100-130 mg/dose 11kg -> 110-143 mg/dose 12kg -> 120-156 mg/dose 13kg -> 130-169 mg/dose 14kg -> 140-182 mg/dose 15kg -> 150-195 mg/dose 16kg -> 160-208 mg/dose 17kg -> 170-221 mg/dose 18kg -> 180-234 mg/dose 19kg -> 190-247 mg/dose 20kg -> 200-260 mg/dose 21kg -> 210-273 mg/dose 22kg -> 220-286 mg/dose 23kg -> 230-299 mg/dose 24kg -> 240-312 mg/dose 25kg -> 250-325 mg/dose 26kg -> 260-338 mg/dose 27kg -> 270-351 mg/dose 28kg -> 280-364 mg/dose 29kg -> 290-377 mg/dose 30kg -> 300-390 mg/dose 31kg -> 310-403 mg/dose 32kg -> 320-416 mg/dose 33kg -> 330-429 mg/dose 34kg -> 340-442 mg/dose 35kg -> 350-450 mg/dose (upper capped) 36kg -> 360-450 mg/dose (upper capped) 37kg -> 370-450 mg/dose (upper capped) 38kg -> 380-450 mg/dose (upper capped) 39kg -> 390-450 mg/dose (upper capped) 40kg -> 400-450 mg/dose (upper capped) 41kg -> 410-450 mg/dose (upper capped) 42kg -> 420-450 mg/dose (upper capped) 43kg -> 430-450 mg/dose (upper capped) 44kg -> 440-450 mg/dose (upper capped) 45kg -> 450 mg/dose (capped) 46kg -> 450 mg/dose (capped) 47kg -> 450 mg/dose (capped) 48kg -> 450 mg/dose (capped) 49kg -> 450 mg/dose (capped) 50kg -> 450 mg/dose (capped) Choice Alternatives. Clindamycin is the oral agent for MRSA that also suppresses toxin production; linezolid is the more expensive and should be kept in reserve. Source IDSA Clinical Practice Guidelines for the Treatment of MRSA Infections in Adults and Children, 2011 Why Lincosamide antibiotic active against MRSA that also suppresses bacterial toxin production; an alternative first-line oral option, though inducible resistance must be excluded if the isolate is erythromycin-resistant. Caution High risk of Clostridioides difficile-associated diarrhea and pseudomembranous colitis; discontinue immediately if severe diarrhea occurs. Check local susceptibility data; perform D-zone test for inducible clindamycin resistance if erythromycin resistant. Egypt ADCOCLINDACE 300 MG 16 CAPS. ARAB DRUG COM... 24.00 EGP (1.50/unit) CLINACYN 300MG 16 CAPS. SIGMA > EGYPT... 31.50 EGP (1.97/unit) CLINDAM 300 MG 16 CAPS. SIGMA > OCTOB... 75.00 EGP (4.69/unit) MEPACLIND 300MG 8 CAPS. MEPACO 38.00 EGP (4.75/unit) CLINDACINE ART 300 MG 12 CAPS. RAMEDA > ART ... 76.00 EGP (6.33/unit) ALFACLINDAMYCIN 300 MG 10 CAPS. ATCO PHARMA >... 69.00 EGP (6.90/unit) DALACIN C 300MG 10 CAPS. PFIZER 114.00 EGP (11.40/unit) KLENDABIOTICAM 1 % TOP. SOLUTION PANAX PHARMA 8.50 EGP -> ? strength differs, ? different route - not oral solid ADCOCLINDACE 10MG/ML TOP. SOL. ARAB DRUG COM... 12.00 EGP -> ? strength differs, ? different route - not oral solid 4. LINEZOLID [2nd line] Adult 600 mg orally twice daily x 7-14 days Peds 10 mg/kg/dose [child max 600 mg] (Children < 12 years: 10 mg/kg per dose orally every 8 hours. Children >= 12 years: 600 mg orally every 12 hours.) 3kg -> 30 mg/dose 4kg -> 40 mg/dose 5kg -> 50 mg/dose 6kg -> 60 mg/dose 7kg -> 70 mg/dose 8kg -> 80 mg/dose 9kg -> 90 mg/dose 10kg -> 100 mg/dose 11kg -> 110 mg/dose 12kg -> 120 mg/dose 13kg -> 130 mg/dose 14kg -> 140 mg/dose 15kg -> 150 mg/dose 16kg -> 160 mg/dose 17kg -> 170 mg/dose 18kg -> 180 mg/dose 19kg -> 190 mg/dose 20kg -> 200 mg/dose 21kg -> 210 mg/dose 22kg -> 220 mg/dose 23kg -> 230 mg/dose 24kg -> 240 mg/dose 25kg -> 250 mg/dose 26kg -> 260 mg/dose 27kg -> 270 mg/dose 28kg -> 280 mg/dose 29kg -> 290 mg/dose 30kg -> 300 mg/dose 31kg -> 310 mg/dose 32kg -> 320 mg/dose 33kg -> 330 mg/dose 34kg -> 340 mg/dose 35kg -> 350 mg/dose 36kg -> 360 mg/dose 37kg -> 370 mg/dose 38kg -> 380 mg/dose 39kg -> 390 mg/dose 40kg -> 400 mg/dose 41kg -> 410 mg/dose 42kg -> 420 mg/dose 43kg -> 430 mg/dose 44kg -> 440 mg/dose 45kg -> 450 mg/dose 46kg -> 460 mg/dose 47kg -> 470 mg/dose 48kg -> 480 mg/dose 49kg -> 490 mg/dose 50kg -> 500 mg/dose AWaRe RESERVE group - last-line agent, protect it. Egyptian EML 2025. Source IDSA Guidelines for the Treatment of Methicillin-Resistant Staphylococcus Aureus Infections 2011 Why Oxazolidinone antibiotic with reliable activity against resistant Gram-positive organisms including MRSA; reserved for infections resistant or intolerant to the first- line oral agents to preserve its usefulness. Caution Reserve for documented MRSA resistant or intolerant to first-line oral agents to preserve susceptibility. Monitor complete blood count weekly if treatment extends beyond 10-14 days due to risk of reversible myelosuppression and thrombocytopenia. Risk of serotonin syndrome when co-administered with serotonergic agents (SSRIs, MAOIs); weak reversible monoamine oxidase inhibitor. Egypt JADOZOLID 600 MG 10 F.C. TAB. KAHIRA > BETA... 79.00 EGP (7.90/unit) THERAZOLIDE 600 MG 20 F.C. TABS. EGPI > TABUK ... 189.00 EGP (9.45/unit) VILZOLID 600 MG 10 F.C. TABS. DELTA GRAND P... 142.00 EGP (14.20/unit) LINEZ 600MG 10 F.C.TAB. SABAA > RAMEDA 159.00 EGP (15.90/unit) LINEZOLID 600MG 14 F.C. TAB. GLOBAL NAPI P... 232.00 EGP (16.57/unit) ELIXOZOLID 600 MG 10 F.C. TABS. RAMEDA > ELIX... 166.00 EGP (16.60/unit) RESPENZO 600 MG 10 F.C.TABS. SIGMA > HOCHS... 206.00 EGP (20.60/unit) AVEROZOLID 600 MG 10 F.C.TAB. EL-OBOUR > AV... 231.00 EGP (23.10/unit) JADOZOLID 100MG/5ML SUSP 60 ML KAHIRA > BETA... 22.80 EGP -> ? strength differs, ? different route - not oral solid SAZIMOLINE 100MG/5ML SUSP. 100 ML RAMEDA > GAMMA PHARMA 23.00 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)