Author Affiliation: Dr Moellering is the Shields Warren-Mallinckrodt Professor of Medical Research, Harvard Medical School, Boston, Massachusetts.
The case of Mr M, a previously healthy 39-year-old man with erythema and swelling of his finger, illustrates the issues involved in treating community-acquired skin and soft tissue infections since the emergence of methicillin-resistant Staphylococcus aureus (MRSA) in the community. Most community-acquired infections of the skin and soft tissues are caused by S aureus or Streptococcus pyogenes. Until recently, infections due to such organisms in the United States could safely be treated with an oral antistaphylococcal penicillin or an oral first-generation cephalosporin. However, the emergence of methicillin-resistant staphylococci as community-acquired pathogens has changed the picture as far as empirical therapy is concerned. Not only do community-acquired MRSA bacteria cause furunculitis and cellulitis, they have also been involved in a variety of more serious and life-threatening infections. Most of these organisms are susceptible to trimethoprim-sulfamethoxazole,
minocycline, doxycycline, and rifampin, and these agents, along with clindamycin, have been used in the therapy of such infections, even though no clinical trials have proven their efficacy. For more serious,
life-threatening infections, linezolid or parenteral agents such as vancomycin or daptomycin should be considered.
Moellering RC. A 39-Year-Old Man With a Skin Infection. JAMA. 2008;299(1):79-87. doi:10.1001/jama.298.21.jrr70002