Q. My son plays football and is in excellent health. Why did he get MRSA?

A. MRSA, or methicellin-resistant staph aureus, is a bacterial infection of the skin and underlying tissues that is becoming more and more common in perfectly healthy children and adolescents. As did other bacteria that developed resistance to amoxicillin and other common antibiotics, staph aureus strains affecting sick, hospitalized patients became highly resistant to traditional anti-staph drugs such as methicillin in the 1990s (hence, the name). The emergence in this decade of similarly resistant strains in the community has alarmed physicians who have seen quite innocent appearing pustules and "insect bites" rapidly progress to more serious deep tissue infections often requiring hospitalization. Oral drugs such as cephalexin (Keflex) and amoxicilin/pot clavulana (Augmentin), which had previously worked promptly, could not stem the worsening infections, which often needed surgical drainage to improve.

National infection control experts have reported outbreaks of MRSA among football teams, fencers, wrestlers and rugby teams. Two factors appear to put these sports at risk. First, breakdown of the skin from trauma such as "turf burns" and frequent abrasive contact with opponents and protective equipment allows entry of MRSA into a player and the transmission to others. Second, the sharing of equipment, clothing and especially personal items such as wet towels and razors will promote spread among team members.

This heightened awareness of MRSA has led doctors to treat to early skin infections more aggressively. Physicians will culture any suspicious wound so that proper antibiotics can be chosen. In the one to two days before lab results are available, drugs effective against MRSA such as sulfamethoxazole/trimethoprim (Bactrim) and clindamycin may be started. Early drainage of pus, essential in any staph infection, is important to prevent worsening and possible hospitalization. Topical measures to eliminate the bacteria from the nasal cavity and the rest of the skin should keep the infection from recurring and spreading to others.