Antibiotics currently used in the treatment of infections caused by Staphylococcus aureus

Abstract

Staphylococcal infections are a common and significant clinical problem in medical practice. Most strains of Staphylococcus aureus are now resistant to penicillin, and methicillin-resistant strains of S. aureus (MRSA) are common in hospitals and are emerging in the community. Penicillinase-resistant penicillins (flucloxacillin, dicloxacillin) remain the antibiotics of choice for the management of serious methicillin-susceptible S. aureus (MSSA) infections, but first generation cephalosporins (cefazolin, cephalothin and cephalexin), clindamycin, lincomycin and erythromycin have important therapeutic roles in less serious MSSA infections such as skin and soft tissue infections or in patients with penicillin hypersensitivity, although cephalosporins are contra-indicated in patients with immediate penicillin hypersensitivity (urticaria, angioedema, bronchospasm or anaphylaxis). All serious MRSA infections should be treated with parenteral vancomycin or, if the patient is vancomycin allergic, teicoplanin. Nosocomial strains of MRSA are typically multi-resistant (mrMRSA), and mrMRSA strains must always be treated with a combination of two oral antimicrobials, typically rifampicin and fusidic acid, because resistance develops rapidly if they are used as single agents. Most community-acquired strains of MRSA in Australia and New Zealand are non multiresistant (nmMRSA), and lincosamides (clindamycin, lincomycin) or cotrimoxazole are the antibiotics of choice for less serious nmMRSA infections such as skin and soft tissue infections. New antibiotics such as linezolid and quinupristin/dalfopristin have good antistaphylococcal activity but are very expensive and should be reserved for patients who fail on or are intolerant of conventional therapy or who have highly resistant strains such as hVISA (heterogenous vancomycin-intermediate S aureus).

Appropriate Empirical Management of Microbial Infections in a Tertiary Care Hospital: A Cost- Effectiveness Approach.

“…Their study also showed that cephalosporins (73.0%) are the most prescribed class of antibiotics followed by fluoroquinolones (53.9%) which are in accordance with our study [10]. As per the study conducted by Dominick et al, it was reported that amikacin, piperacillin+tazobactam, cefepime, and nitrofurantoin were the most preferred drug in E. coli and K. pneumonia ESBL infection to avoid resistance to beta-lactams (meropenem and imipenem) which were expensive and could be used for more severe infections instead [11]. As stated by Rayner and Munckhof in their study conducted in Poland, penicillinase-resistant penicillins (flucloxacillin and dicloxacillin) were the best drugs in the treatment of severe infections of methicillin-sensitive S. aureus and acute infections, the first generation cephalosporins, and clindamycin could be used [4].…”

Spectrum of constitutive and inducible clindamycin resistance in Staphylococcus spp isolated from clinical samples and its relation with methicillin resistance.

“…Good oral absorption makes this drug an important option in outpatient therapy and as a follow-up after intravenous therapy. [18] In recent times, clindamycin has become the drug of choice for Staphylococcal skin and soft tissue infections as it directly inhibits the Staphylococcal toxin production. Clindamycin attains high concentrations in abscesses and requires no renal dose adjustments .It can be used as an alternative in penicillin-allergic patients.…”

“…Clindamycin attains high concentrations in abscesses and requires no renal dose adjustments .It can be used as an alternative in penicillin-allergic patients. [18] It is effective against both methicillin resistant and the methicillin sensitive Staphylococcal isolates. [5] Annals of Pathology and Laboratory Medicine, Vol.…”

In vitro Antibacterial activity of Nigella Sativa extract against clinical Isolates of Methicillin Resistant Staphylococcus Aureus

“…The organism colonizes skin, skin glands and mucous membrane, causing infections such as rashes, inflammations of bones and the meninges as well as septicemia (5) . Penicillin and its derivatives, including methicillin have been used for the treatments of infections caused by S. aureus (6) . However, certain strains of S. aureus developed resistance known as methicillin resistant Staphylococcus aureus (MRSA).…”