PORTLAND, ORE. — Recurrent infections with methicillin-resistant Staphylococcus aureus are common in children, and the effectiveness of the available treatments is “modest at best,” Sarah S. Long, M.D., said at a conference sponsored by the North Pacific Pediatric Society.
Still, one must try something because repeated episodes of furunculosis are so common in children. S. aureus colonizes the nasal passages, and when a child picks her nose, the infection can spread to anything the child touches. Especially vulnerable are areas with microabrasions, such as the diaper area and any place the child has eczema, said Dr. Long of Drexel University, Philadelphia.
About 70% of the cases of S. aureus infection in her hospital are community acquired and methicillin resistant. Because of that, “you now have to consider the bacteriology of every case,” she said.
Gone are the days when one could use amoxicillin/clavulanate because of its activity against staph and strep. Now once a furuncle is drained, “everybody deserves to have a culture” with susceptibility testing. Dr. Long said.
No one strategy against recurrent methicillin-resistant S. aureus (MRSA) has more than modest effectiveness. Nevertheless, she described the available strategies and how she might apply them.
▸ A repeat course of antibiotics is certainly indicated, but only after susceptibility testing to ensure that the antibiotic will be effective. Dr. Long said she might try a third course of antibiotics if the infection recurred.
▸ Rifampin by itself gives unimpressive results, but it can reduce MRSA colonization. At about the third recurrence, Dr. Long would add oral rifampin, 10 mg/kg per day, toward the end of a course of antibiotics.
▸ Alternatively, the third recurrence may be the time to use mupirocin applied in the nasal passages twice a day for 2 weeks.
▸ By the fourth recurrence, Dr. Long will combine rifampin, mupirocin, and a course of antibiotics.
Additionally, there are several hygiene measures that physicians may wish to recommend to the parents.
▸ Shower the child using chlorhexidine (Hibiclens) once a day for 2 weeks, and then once every 3 days. This reduces the chance that S. aureus will colonize various sites on the skin. But one note of caution: Chlorhexidine can cause dry skin, and parents should keep an eye out for this.
▸ It's important to take aggressive care of diaper rashes, which can easily be complicated by MRSA infections.
▸ Have the parent empty and clean the bathroom thoroughly. Soap, toothpaste, toothbrushes, and cosmetics all are frequently contaminated by S. aureus. “Do a blitz on the bathroom,” Dr. Long advised.
▸ Ensure that all family members use separate towels and washcloths because these are common vectors for the spread of staph infections. This precaution is critical for older children involved in sports, such as wrestling, where abrasions are commonplace.