TREATMENT OF STAPHYLOCOCCAL INFECTIONS

Staphylococcal infections are a major clinical problem as they are ass ociated with a high mortality rate. In this review we discuss the vari ous antibiotics available for treating staphylococcal infections. Stap hylococci induce infection either by direct invasion, resulting in ski n and soft tissue infections, bacteraemia or endocarditis, or through the release of toxins, resulting in scalded skin syndrome, food poison ing or toxic shock syndrome. The development of resistance has limited the options available for treatment of staphylococcal infections. bet a-Lactamase-resistant penicillins, such as nafcillin, oxacillin and fl ucloxacillin, are important for the treatment of methicillin-susceptib le strains. For infections with methicillin-resistant strains, however , glycopeptides remain the drugs of choice. Wound, soft tissue and ski n infections associated with Staphylococcus aureus can be treated oral ly with flucloxacillin or classical cephalosporins. Staphylococcus aur eus endocarditis usually responds to parenteral treatment with a beta- lactam plus an aminoglycoside, although vancomycin remains the standar d treatment for endocarditis caused by methicillin-resistant staphyloc occi. Staphylococcal osteomyelitis in adults should receive prolonged treatment with an antistaphylococcal penicillin (minimum of 4-6 weeks parenterally plus 6-12 months orally). For infections of prosthetic jo ints or intravascular devices it is necessary to remove the device and initiate treatment with antistaphylococcal antibiotics. Treatment sho uld be continued for up to 6 weeks if septicaemia and endocarditis are also present. Toxic shock syndrome caused by a toxin produced by Stap hylococcus aureus responds to antistaphylococcal antibiotics and suppo rtive treatment. Staphylococcal scalded skin syndrome occurs in neonat es as a result of a Staphylococcus aureus exfoliatin. Treatment involv es fluid replacement and antistaphylococcal antibiotics for up to 2 we eks. Future possible antimicrobials for staphylococcal infections incl ude the new quinolones, which have shown increased activity against st aphylococci and the streptogramins.