The clinician's choice of antibiotics in the treatment of bacterial skin infection

The development of modern antibiotics has vastly improved the therapy of cu taneous bacterial infections, particularly those caused by Staphylococcus a ureus. This organism and beta-haemolytic streptococci are the most common c utaneous pathogens. A growing body of evidence suggests that proteins from S. aureus and some strains of streptococci can act as superantigens and cau se polyclonal T-cell activation by binding directly to antigen-presenting c ells. This process is a likely explanation of Kawasaki's syndrome as well a s staphylococcal and streptococcal toxic shock syndrome. Sudden aggravation of atopic dermatitis, contact dermatitis and some cases of psoriasis can b e similarly explained. Bacterial toxins can precipitate the staphylococcal scalded skin syndrome. Specific and effective eradication of bacteria and p rogrammes to prevent recurrences are important, particularly in immune supp ressed persons. Topical antibiotics used primarily for superficial infectio ns of limited extent and for the prevention of recurrences in carriers of S . aureus should be combined with the use of topical disinfectants. The trea tment of selected bacterial skin infections based on clinical examples will be discussed. These include secondarily infected dermatoses, cellulitis an d streptococcal carriage in the ano-genital region and staphylococcal folli culitis and nasal carriage.