Methicillin-resistant Staphylococcus aureus therapy: past, present, and future

Methicillin-resistant Staphylococcus aureus (MRSA) continues to be associated with significant morbidity and mortality. Vancomycin was the "gold standard" of treatment for serious MRSA infections; however, the emergence of less-susceptible strains, poor clinical outcomes, and increased nephrotoxicity with high-dose therapy are challenging its current role as first-line therapy. Linezolid is recommended for PO or IV treatment of skin and skin structure infections (SSSIs) and pneumonia caused by MRSA. Daptomycin (IV) should be considered in patients with MRSA bacteremia and right-sided endocarditis as well as in complicated SSSIs, but should not be used to treat MRSA pneumonia. Tigecycline and telavancin are alternative (IV) treatments for SSSIs caused by MRSA; however, safety concerns have limited use of these agents. Ceftaroline is the newest of the approved parenteral agents for SSSIs caused by MRSA. Several investigational agents with activity against drug-resistant gram-positive pathogens are being developed primarily for treatment of MRSA infections, including tedizolid, dalbavancin, and oritavancin.