Advances in methicillin-resistant Staphylococcus aureus drug discovery: developments and challenges

Introduction: Methicillin-resistant Staphylococcus aureus (MRSA) is a leading cause of severe infections with excess mortality. Progress with traditional antibiotics has been incremental, while resistance, persistence, tolerance, and biofilm formation continue to erode effectiveness. Parallel advances in small-molecule discovery, long-acting lipoglycopeptides, next-generation β-lactams, and non-traditional modalities such as bacteriophage lysins have renewed interest in expanding therapeutic options, though transition from promising preclinical signals to clinical benefit remains challenging. Areas covered: A literature search was conducted using PubMed/MEDLINE, and Embase, for articles published from January 2010 through March 2025. This review synthesizes developments across: (i) agents in key clinical trials for invasive MRSA infection, emphasizing on trial designs, efficacy, and safety considerations; (ii) clinical study data with newer agents for MRSA skin infections and their potential application in invasive disease; (iii) preclinical pipelines including natural products, novel compounds, and other innovative antimicrobial strategies. Expert opinion: Among investigated agents, ceftobiprole, ceftaroline, dalbavancin, and exebacase represent promising options for invasive MRSA infections. The pipeline is further strengthened by novel classes and antimicrobial peptides, which show anti-MRSA activity and a low risk for resistance in preclinical models. Continued multidisciplinary collaboration and robust clinical trial infrastructure are essential to translate these advances into improved patient outcomes.