While MRSA and cellulitis are common in Arkansas communities, diagnosing and treating them appropriately—especially in outpatient settings—can be more complex. Dr. Amanda Novack, infectious disease specialist at Baptist Health, covers key tips, treatment pitfalls, and evolving approaches to care.
For a breakdown of what MRSA and cellulitis are, who’s most at risk, and how to spot the warning signs early, check out Part 1 of this series.
MRSA Treatment Misconceptions and Mistakes
Treating MRSA improperly can lead to much bigger problems. Dr. Novack shared some common mistakes she sees—and how to avoid them:
Not draining the abscess
“Insufficient source control is a big mistake in treating MRSA,” Dr. Novack says. “For a localized abscess, adequate incision and drainage (I&D) are often the most crucial step.”
If there’s a pus-filled lump, antibiotics alone aren’t usually enough. The infection is trapped under the skin and needs to be drained properly. Without this step, the antibiotics can’t reach the infection site.
Using the wrong antibiotics
Some doctors give very strong (broad-spectrum) antibiotics for skin infections that don’t show signs of MRSA, like pus or drainage. But they can do more harm than good.
“Using broad-spectrum antibiotics like vancomycin or linezolid for uncomplicated, non-purulent cellulitis increases the risk of antibiotic resistance and C. difficile infection without necessarily improving outcomes,” Dr. Novack explains.
These antibiotics should be saved for more serious infections only when needed.
Not checking local resistance patterns
“It’s important to be aware of local antibiogram data when making empiric choices,” says Dr. Novack.
In other words, doctors should know how common MRSA is in their area and which antibiotics still work against it.
Skipping follow-up
If the patient is being treated outside the hospital, follow-up is key. If the infection isn’t getting better, the doctor can easily change the treatment. Patients should also know when to come back or when to seek help, especially if conditions worsen.
Not knowing medication limits
Drugs like Bactrim (trimethoprim-sulfamethoxazole), clindamycin, doxycycline, and minocycline can work well for mild MRSA infections, but they’re not perfect. Some have side effects, and bacteria may not always respond to them.
“Clindamycin resistance, for example, can be an issue,” Dr. Novack notes.
How Antibiotic Resistance is Changing Treatment
Over time, some bacteria, including MRSA, have become harder to treat because they’ve developed a resistance to common antibiotics. This means that doctors now have to make tougher decisions when choosing the right medicine for a patient.
Here’s how antibiotic resistance is changing the way MRSA is treated in Arkansas:
Stronger antibiotics are sometimes needed.
When standard antibiotics no longer work, doctors may have to use stronger ones like vancomycin, linezolid, or daptomycin. These drugs can be life-saving but come with more side effects and higher costs.
Testing bacteria is more important than ever.
If MRSA is suspected, doctors will often send a sample of the infection to the lab for testing. This helps identify which antibiotics work best, and which ones to avoid.
“When MRSA is suspected or confirmed, we increasingly rely on culture and susceptibility testing to guide antibiotic selection,” Dr. Novack explains.
Antibiotic stewardship is a must.
Being mindful of how and when antibiotics are prescribed will help protect their effectiveness against bacteria.
“We need to be more judicious in our antibiotic prescribing,” Dr. Novack says. That means saving stronger drugs for when they’re truly needed and stopping or switching medications when the patient improves.
Alternative approaches are sometimes needed.
For stubborn, recurring infections, doctors may try other strategies, like longer courses of oral antibiotics, maintenance therapy, or referrals to infectious disease specialists.
New and Promising Treatment Options
Doctors now have more options than ever for treating MRSA and cellulitis, especially when it comes to making treatment easier and more effective for patients outside the hospital.
Single-dose IV antibiotics
Some newer antibiotics, like oritavancin, dalbavancin, and telavancin, only require one dose or one dose per week. That means fewer trips to the doctor’s office or hospital.
“These can be particularly useful in outpatient settings for patients with challenges adhering to multi-day regimens,” Dr. Novack says.
However, these drugs are often expensive and may not be the right choice for every patient. They also come with specific risks and side effects, so doctors need to be thoughtful about when to use them.
Newer oral medications
There’s growing interest in antibiotics like tedizolid and delafloxacin, which are good options for patients with less severe infections or those moving from hospital to home care.
“These offer valuable options for step-down therapy or for treating less severe outpatient infections,” Dr. Novack says.
Delafloxacin is especially helpful for infections that involve both MRSA and other bacteria, like Gram-negative organisms.
Treatments on the horizon
Researchers are working on new antibiotics—and even non-antibiotic therapies—to fight drug-resistant infections. These future treatments could be more targeted, with fewer side effects.
“While many are still in the early stages,” Dr. Novack explains, “the future may bring more targeted and effective therapies.”
Diagnosis and Management Tips in Outpatient Settings
Dr. Novack offers several practical takeaways for urgent and primary care providers who manage skin and soft tissue infections. These tips can help improve patient outcomes and support antibiotic stewardship.
Look for signs of purulence.
Palpate the lesion for fluid collection (fluctuance), ask when symptoms began, and find out how the area has changed over time. Recognizing pus is critical—it signals a higher chance of MRSA and helps a doctor determine next steps.
Don't delay incision and drainage (I & D).
“For localized abscesses, early and adequate I&D is paramount,” Dr. Novack says.
If the infection is drainable, antibiotics alone aren’t enough. Drainage removes the source of infection and gives antibiotics a chance to work effectively. Send samples for culture and sensitivity testing, especially if the infection is severe or recurrent.
Choose antibiotics wisely.
For non-purulent cellulitis, stick with beta-lactam antibiotics (like cephalexin or amoxicillin-clavulanate). Reserve MRSA-active antibiotics (like Bactrim, doxycycline, and clindamycin) for:
- Purulent infections
- Prior MRSA history
- Failed initial antibiotic therapy
- Severe or systemic symptoms
“Reserve MRSA coverage for cases with clear indications,” Dr. Novack advises.
Consider decolonization for repeat infections.
In cases of recurring abscesses, discuss decolonization protocols. Options include:
- Nasal mupirocin (twice daily for 5–10 days)
- Chlorhexidine (CHG) body washes
- Household surface cleaning
These aren’t cure-alls, but they may reduce MRSA recurrence.
Know when to refer.
Don’t hesitate to refer patients with:
- Worsening infections
- Lack of response to initial therapy
- High-risk factors (e.g., immunocompromised, rapidly spreading infections)
Consult an infectious disease specialist or surgeon if more advanced care is needed.
What's Next for MRSA and Cellulitis Treatment?
Looking ahead, Dr. Novack, sees several promising developments that could change how we prevent and treat MRSA, especially in high-risk or hard-to-treat cases.
Greater focus on prevention
Expect more emphasis on stopping infections before they start. This could include:
- Decolonization protocols for people with repeat MRSA infections
- Hygiene education in schools, athletic programs, and correctional facilities
- Expanded access to wound care in rural areas
Better diagnostic tools
New point-of-care tests could help providers identify bacteria and resistance patterns much faster, leading to more targeted treatments and fewer unnecessary antibiotics.
Smarter, more personalized treatments
In the future, we may see more individualized care based on:
- The patient’s health conditions
- Local resistance patterns
- Specific characteristics of the infecting bacteria
This could mean tailored antibiotic choices, or even immune-boosting therapies that reduce the need for antibiotics altogether.
New antibiotics on the horizon
Research continues on new drugs and alternative treatments. While many are still in development, they could offer ways to treat infections that don’t respond to current options.
“The pipeline of novel antibiotics and non-antibiotic therapies will hopefully yield more options to combat resistant strains,” Dr. Novack says.
Continued antibiotic stewardship
As resistance grows, being thoughtful with antibiotics is more important than ever. This means:
- Avoiding unnecessary broad-spectrum antibiotics
- De-escalating treatment based on culture results
- Educating patients about responsible antibiotic use
“Antibiotic stewardship will remain a critical focus,” Dr. Novack says, “to preserve the effectiveness of our existing and future microbial agents.”
Final Thoughts
From recognizing when to drain an abscess to choosing the right antibiotic, managing MRSA requires a mix of clinical judgment, local awareness, and evolving tools. As resistance continues to rise, outpatient providers play a key role in preventing complications and preserving the effectiveness of our treatments. With smarter diagnostics, better prevention strategies, and ongoing stewardship, we can move toward more personalized, effective care for skin infections in every community.
