Dawaa Reference

infectious

Community-Acquired MRSA Skin and Soft Tissue Infection

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources4 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 against3 documents
  • 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

Verified date2026-08

Presentation reference

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

SourceStatPearls "Methicillin-Resistant Staphylococcus aureus" - disease-level clinical article

Presentation findings are traced to the source above.

1

SULPHAMETHOXAZOLE + TRIMETHOPRIM

1st line

Strength800 mg

Formoral.solid

Adult dose and duration

800/160 mg (1 double-strength tablet) to 1600/320 mg (2 double-strength tablets) orally twice daily x 5-10 days

Paediatric dose

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.)

Dose by age
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.
Dose by weight
3kg12-18 mg/dose
4kg16-24 mg/dose
5kg20-30 mg/dose
6kg24-36 mg/dose
7kg28-42 mg/dose
8kg32-48 mg/dose
9kg36-54 mg/dose
10kg40-60 mg/dose
11kg44-66 mg/dose
12kg48-72 mg/dose
13kg52-78 mg/dose
14kg56-84 mg/dose
15kg60-90 mg/dose
16kg64-96 mg/dose
17kg68-102 mg/dose
18kg72-108 mg/dose
19kg76-114 mg/dose
20kg80-120 mg/dose
21kg84-126 mg/dose
22kg88-132 mg/dose
23kg92-138 mg/dose
24kg96-144 mg/dose
25kg100-150 mg/dose
26kg104-156 mg/dose
27kg108-160 mg/dose (upper capped)
28kg112-160 mg/dose (upper capped)
29kg116-160 mg/dose (upper capped)
30kg120-160 mg/dose (upper capped)
31kg124-160 mg/dose (upper capped)
32kg128-160 mg/dose (upper capped)
33kg132-160 mg/dose (upper capped)
34kg136-160 mg/dose (upper capped)
35kg140-160 mg/dose (upper capped)
36kg144-160 mg/dose (upper capped)
37kg148-160 mg/dose (upper capped)
38kg152-160 mg/dose (upper capped)
39kg156-160 mg/dose (upper capped)
40kg160 mg/dose (capped)
41kg160 mg/dose (capped)
42kg160 mg/dose (capped)
43kg160 mg/dose (capped)
44kg160 mg/dose (capped)
45kg160 mg/dose (capped)
46kg160 mg/dose (capped)
47kg160 mg/dose (capped)
48kg160 mg/dose (capped)
49kg160 mg/dose (capped)
50kg160 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.

Dose 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.

Cautions
  • 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).
Egyptian brands
Egyptian brandManufacturerIndicative price
CO-TRIMOXAZOLE 20 TABS.? strength differsMUP5.00 EGP (0.25/unit)
COTRIL 400/80MG 20 TAB.? strength differsEL NASR38.00 EGP (1.90/unit)
SEPTAZOLE FORTE 800/160MG 20 TABS.? strength differsALEXANDRIA56.00 EGP (2.80/unit)
SEPTRIN D.S 10 TABS.? strength differsGLAXO SMITHKLINE > ASPEN PHARMA TRADING LIMITED28.00 EGP (2.80/unit)
SEPTAZOLE 400/80MG 20*10 TABS.? strength differsALEXANDRIA340.00 EGP (34.00/unit)
SUTRIM 400/80MG 20*10 TAB.? strength differsMEMPHIS340.00 EGP (34.00/unit)
CO-TRIMOXAZOLE 200/40MG SUSP. 120ML? strength differs? different route - not oral solidMUP6.00 EGP
SUTRIM 200/40MG SUSP. 100ML? strength differs? different route - not oral solidMEMPHIS18.50 EGP
2

DOXYCYCLINE

1st line

Strength100 mg

Formoral.solid

Adult dose and duration

100 mg orally twice daily x 5-10 days

Paediatric dose

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.)

Dose by 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.
Dose by weight
3kg6.6 mg/dose
4kg8.8 mg/dose
5kg11 mg/dose
6kg13.2 mg/dose
7kg15.4 mg/dose
8kg17.6 mg/dose
9kg19.8 mg/dose
10kg22 mg/dose
11kg24.2 mg/dose
12kg26.4 mg/dose
13kg28.6 mg/dose
14kg30.8 mg/dose
15kg33 mg/dose
16kg35.2 mg/dose
17kg37.4 mg/dose
18kg39.6 mg/dose
19kg41.8 mg/dose
20kg44 mg/dose
21kg46.2 mg/dose
22kg48.4 mg/dose
23kg50.6 mg/dose
24kg52.8 mg/dose
25kg55 mg/dose
26kg57.2 mg/dose
27kg59.4 mg/dose
28kg61.6 mg/dose
29kg63.8 mg/dose
30kg66 mg/dose
31kg68.2 mg/dose
32kg70.4 mg/dose
33kg72.6 mg/dose
34kg74.8 mg/dose
35kg77 mg/dose
36kg79.2 mg/dose
37kg81.4 mg/dose
38kg83.6 mg/dose
39kg85.8 mg/dose
40kg88 mg/dose
41kg90.2 mg/dose
42kg92.4 mg/dose
43kg94.6 mg/dose
44kg96.8 mg/dose
45kg99 mg/dose
46kg100 mg/dose (capped)
47kg100 mg/dose (capped)
48kg100 mg/dose (capped)
49kg100 mg/dose (capped)
50kg100 mg/dose (capped)
Dose 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.

Cautions
  • 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.
Egyptian brands
Egyptian brandManufacturerIndicative price
FARCODOXIN 100MG 10 CAPS.PHARCO11.00 EGP (1.10/unit)
DOXY M.R.100 MG 10 CAPS.ADWIA12.00 EGP (1.20/unit)
GRANUDOXY 100MG 10 F.C. TAB.GLOBAL NAPI PHARMACEUTICALS > PIERRE FRANCE12.00 EGP (1.20/unit)
DOXYDOX 100 MG 10 CAPS.EIPICO23.00 EGP (2.30/unit)
DOXYMYCIN 100 MG 10 CAPS.EL NILE.30.00 EGP (3.00/unit)
TABOCINE 100MG 10 CAPS.TABUK PHARMACEUTICAL MANUFACTURING COMPANY > TABUK PHARMA46.00 EGP (4.60/unit)
VIBRAMYCIN 100MG 10 CAPS.PFIZER65.00 EGP (6.50/unit)
3

CLINDAMYCIN

2nd line

Strength300 mg

Formoral.solid

Adult dose and duration

300-450 mg orally three times daily x 5-10 days

Paediatric dose

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.)

Dose by weight
3kg30-39 mg/dose
4kg40-52 mg/dose
5kg50-65 mg/dose
6kg60-78 mg/dose
7kg70-91 mg/dose
8kg80-104 mg/dose
9kg90-117 mg/dose
10kg100-130 mg/dose
11kg110-143 mg/dose
12kg120-156 mg/dose
13kg130-169 mg/dose
14kg140-182 mg/dose
15kg150-195 mg/dose
16kg160-208 mg/dose
17kg170-221 mg/dose
18kg180-234 mg/dose
19kg190-247 mg/dose
20kg200-260 mg/dose
21kg210-273 mg/dose
22kg220-286 mg/dose
23kg230-299 mg/dose
24kg240-312 mg/dose
25kg250-325 mg/dose
26kg260-338 mg/dose
27kg270-351 mg/dose
28kg280-364 mg/dose
29kg290-377 mg/dose
30kg300-390 mg/dose
31kg310-403 mg/dose
32kg320-416 mg/dose
33kg330-429 mg/dose
34kg340-442 mg/dose
35kg350-450 mg/dose (upper capped)
36kg360-450 mg/dose (upper capped)
37kg370-450 mg/dose (upper capped)
38kg380-450 mg/dose (upper capped)
39kg390-450 mg/dose (upper capped)
40kg400-450 mg/dose (upper capped)
41kg410-450 mg/dose (upper capped)
42kg420-450 mg/dose (upper capped)
43kg430-450 mg/dose (upper capped)
44kg440-450 mg/dose (upper capped)
45kg450 mg/dose (capped)
46kg450 mg/dose (capped)
47kg450 mg/dose (capped)
48kg450 mg/dose (capped)
49kg450 mg/dose (capped)
50kg450 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.

Dose 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.

Cautions
  • 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.
Egyptian brands
Egyptian brandManufacturerIndicative price
ADCOCLINDACE 300 MG 16 CAPS.ARAB DRUG COMPANY (ADCO)24.00 EGP (1.50/unit)
CLINACYN 300MG 16 CAPS.SIGMA > EGYPTIAN PHARMACISTS COMPANY31.50 EGP (1.97/unit)
CLINDAM 300 MG 16 CAPS.SIGMA > OCTOBER PHARMA75.00 EGP (4.69/unit)
MEPACLIND 300MG 8 CAPS.MEPACO38.00 EGP (4.75/unit)
CLINDACINE ART 300 MG 12 CAPS.RAMEDA > ART PHARMA76.00 EGP (6.33/unit)
ALFACLINDAMYCIN 300 MG 10 CAPS.ATCO PHARMA > ROTABIOGEN69.00 EGP (6.90/unit)
DALACIN C 300MG 10 CAPS.PFIZER114.00 EGP (11.40/unit)
KLENDABIOTICAM 1 % TOP. SOLUTION? strength differs? different route - not oral solidPANAX PHARMA8.50 EGP
ADCOCLINDACE 10MG/ML TOP. SOL.? strength differs? different route - not oral solidARAB DRUG COMPANY (ADCO)12.00 EGP
4

LINEZOLID

2nd line

Strength600 mg

Formoral.solid

Adult dose and duration

600 mg orally twice daily x 7-14 days

Paediatric dose

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.)

Dose by weight
3kg30 mg/dose
4kg40 mg/dose
5kg50 mg/dose
6kg60 mg/dose
7kg70 mg/dose
8kg80 mg/dose
9kg90 mg/dose
10kg100 mg/dose
11kg110 mg/dose
12kg120 mg/dose
13kg130 mg/dose
14kg140 mg/dose
15kg150 mg/dose
16kg160 mg/dose
17kg170 mg/dose
18kg180 mg/dose
19kg190 mg/dose
20kg200 mg/dose
21kg210 mg/dose
22kg220 mg/dose
23kg230 mg/dose
24kg240 mg/dose
25kg250 mg/dose
26kg260 mg/dose
27kg270 mg/dose
28kg280 mg/dose
29kg290 mg/dose
30kg300 mg/dose
31kg310 mg/dose
32kg320 mg/dose
33kg330 mg/dose
34kg340 mg/dose
35kg350 mg/dose
36kg360 mg/dose
37kg370 mg/dose
38kg380 mg/dose
39kg390 mg/dose
40kg400 mg/dose
41kg410 mg/dose
42kg420 mg/dose
43kg430 mg/dose
44kg440 mg/dose
45kg450 mg/dose
46kg460 mg/dose
47kg470 mg/dose
48kg480 mg/dose
49kg490 mg/dose
50kg500 mg/dose
AWaRe

RESERVE group - last-line agent, protect it. Egyptian EML 2025.

Dose 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.

Cautions
  • 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.
Egyptian brands
Egyptian brandManufacturerIndicative price
JADOZOLID 600 MG 10 F.C. TAB.KAHIRA > BETA PHARMA-EGYPT79.00 EGP (7.90/unit)
THERAZOLIDE 600 MG 20 F.C. TABS.EGPI > TABUK PHARMA189.00 EGP (9.45/unit)
VILZOLID 600 MG 10 F.C. TABS.DELTA GRAND PHARMA > PARKVILLE142.00 EGP (14.20/unit)
LINEZ 600MG 10 F.C.TAB.SABAA > RAMEDA159.00 EGP (15.90/unit)
LINEZOLID 600MG 14 F.C. TAB.GLOBAL NAPI PHARMACEUTICALS232.00 EGP (16.57/unit)
ELIXOZOLID 600 MG 10 F.C. TABS.RAMEDA > ELIXIR PHARMA166.00 EGP (16.60/unit)
RESPENZO 600 MG 10 F.C.TABS.SIGMA > HOCHSTER PHARMACEUTICAL INDUSTRIES206.00 EGP (20.60/unit)
AVEROZOLID 600 MG 10 F.C.TAB.EL-OBOUR > AVERROES PHARMA-EGYPT231.00 EGP (23.10/unit)
JADOZOLID 100MG/5ML SUSP 60 ML? strength differs? different route - not oral solidKAHIRA > BETA PHARMA-EGYPT22.80 EGP
SAZIMOLINE 100MG/5ML SUSP. 100 ML? strength differs? different route - not oral solidRAMEDA > GAMMA PHARMA23.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.