The increasing incidence of a variety of
infections due to Staphylococcus aureus--and, especially, the expanding role of community-associated methicillin-resistant S. aureus (MRSA)--has led to emphasis on the need for safe and effective agents to treat both systemic and localized
staphylococcal infections. Unlike most previously noted strains of health care-associated MRSA, community-acquired MRSA isolates are often susceptible to several non-
beta -lactam drug classes, although they are usually not susceptible to
macrolides. Several newer
antimicrobial agents and a few older agents are available for treatment of systemic
staphylococcal infections, but use may be limited by the relatively high cost of these agents or the need for parenteral administration. Inexpensive oral agents for treatment of localized, community-acquired MRSA
infection include
clindamycin,
trimethoprim-sulfamethoxazole, and newer
tetracyclines.
Clindamycin has been used successfully to treat
pneumonia and soft-tissue and musculoskeletal
infections due to MRSA in adults and children. However, concern over the possibility of emergence of
clindamycin resistance during
therapy has discouraged some clinicians from prescribing that agent. Simple laboratory testing (e.g., the
erythromycin-
clindamycin "D-zone" test) can separate strains that have the genetic potential (i.e., the presence of erm genes) to become resistant during
therapy from strains that are fully susceptible to
clindamycin.