Optimal treatment of complicated skin and skin structure infections

Gram-positive bacteria (e.g. Staphylococcus aureus and Streptococcus pyogen es) are the main cause of skin and skin structure infections (SSSI). Treatm ent presents a clinical challenge to the physician, particularly with the i ncrease in multidrug-resistant strains and widespread cross-resistance to a ntibiotic treatment. Initial treatment of SSSI involves the use of fluoro-q uinolones or penicillinase-resistant penicillins. If infection is caused by methicillin-resistant staphylococci, therapy with glycopeptides is warrant ed. However, in the last few years several cases of infection caused by str ains of S. aureus with reduced susceptibility to glycopeptides have been re ported. Quinupristin/dalfopristin is a new streptogramin that has shown eff icacy in the management of multidrug-resistant Gram-positive infections. Tw o major studies suggest that in the treatment of complicated SSSI, the clin ical efficacy of quinupristin/dalfopristin is equivalent to that of vancomy cin and/or oxacillin and vancomycin and/or cefazolin.