Table 5.

Therapeutic options for managing MRSA infections

Serial number	Drug name	Drug class	Mechanism of action	Bacteriostatic/bactericidal	Route of administration	Indications	Major adverse effects
1	Vancomycin	Glycopeptide	Vancomycin inhibits the cross-linking within peptidoglycan layer of bacterial cell wall	Bactericidal (variable)	IV	MRSA, Staphylococcus endocarditis, and Diphtheroid endocarditis	Infusion-related anaphylactoid reactions, nephrotoxicity, pseudomembranous colitis, ototoxicity, neutropenia, and phlebitis
2	Linezolid	Oxazolidinone	Inhibits bacterial protein synthesis	Bacteriostatic	IV and oral	SSTI, vancomycin-resistant Enterococcus faecium infections, nosocomial pneumonia	Diarrhea, vomiting, headache, nausea, and anemia
3	Tigecycline	Glycylcycline	Bacteriostatic: inhibits protein translation in bacteria by binding to the 30 S ribosomal subunit	Bacteriostatic	IV	Complicated skin and skin structure infections (cSSSI), complicated intra-abdominal infections, and community-acquired bacterial pneumonia	Nausea, vomiting, diarrhea, abdominal pain, headache, and increased serum glutamic pyruvic transaminase (SGPT)
4	Teicoplanin	Glycopeptide	Inhibits bacterial cell wall synthesis	Bactericidal	IM or IV	Skin and soft tissue infections, urinary tract infections, lower respiratory tract infections, joint and bone infections, septicemia, endocarditis, and peritonitis related to continuous ambulatory peritoneal dialysis	Local reactions, hypersensitivity, increased transaminases, eosinophilia, thrombocytopenia, increase in serum creatinine, blood urea, renal failure, hearing loss, and tinnitus
5	Daptomycin	Cyclic lipopeptide	Bacterial cell membrane lysis	Bactericidal	IV	cSSSI, Staphylococcus aureus bloodstream infections (bacteremia), right-sided infective endocarditis	Diarrhea, headache, dizziness, rash, abnormal liver function tests, elevated creatine phosphokinase (CPK), urinary tract infections, hypotension, and dyspnea
6	Ceftaroline	Cephalosporins	Bactericidal: binds to essential penicillin-binding protein	Bactericidal	IV	ABSSI and CAP	Diarrhea, nausea, rash, vomiting, and pyrexia
7	Ceftobiprole	Cephalosporins	Has high affinity for PBP2a of MRSA	Bactericidal	IV	HAP, VAP, and CAP	Hypersensitivity reactions, Clostridium difficile-associated, direct Coombs’ test seroconversion
8	Clindamycin	Lincosamide antibiotic	Inhibits bacterial protein synthesis at the level of the 50S ribosome	Bacteriostatic	IV or oral	Skin and skin structure infections, gynecological infections, intra-abdominal infections, septicemia, and bone and joint infections	Pruritus, rash, urticarial, abdominal pain, diarrhea, and esophagitis

MRSA, methicillin-resistant Staphylococcus aureus; IV, intravenous; IM, intramuscular; ABSSI, acute bacterial skin and skin structure infections; HAP, hospital-acquired pneumonia; CAP, community-acquired pneumonia; VAP, ventilator-associated pneumonia; SSTI, skin and soft tissue infection