Clinical CA-MRSA Abscess Care and Treatment Guidelines in Urgent Care Practice Urgent message: In the absence of controlled outpatient trials, the author proposes urgent-care specific guidelines for treatment of community-acquired MRSA, informed by clinical experience and local and regional case reports. Michael Dickey, MD he goal of any treatment is to maximize the chance of a positive outcome for a patient. The purpose of a treatment guideline is to maximize the chance of posi- tive outcomes in groups of pa- tients that present with a sim- ilar disease states. While there remain “many ways to skin a cat,” the theory behind the use of treatment guidelines in the primary care specialties and subspecial- ties—including urgent care— is not necessarily complete uniformity of treatment, but to assure that treatment is consistent with available evi- dence from the medical literature. The best treatment plan utilizes those treatment op- tions that appear to show higher cure rates and shorter treatment intervals. T BACKGROUND Ideally, we would have multiple large, controlled, com- w w w. j u c m . c o m munity-based outpatient trials comparing various treatment options and combinations of treatments for community- acquired methicillin-resistant Staphylococcus aureus (CA- MRSA). In the imperfect world of clinical medical practice, how- ever, we do not always have perfect evidence to rely on. The reality is that, to date, there is little controlled re- search on the treatment of CA- MRSA, probably owing much to the recent genesis of this problem, but also due to the difficulty of controlled trials on such a genetically diverse disease agent as CA-MRSA. Some of the most useful clinical information available at present comes from case reports. This proposed treatment guideline is also influenced by the author’s observations during treatment of ap- proximately 1,200 cases of skin and soft tissue infections (SSTIs), of which approximately 85% were CA-MRSA, during a five-year interval (2002-2007). © GettyImages.com/3D4Medical.com PURPOSE JUCM T h e J o u r n a l o f U r g e n t C a r e M e d i c i n e | J a n u a r y 2 0 0 8 11