TREATMENT OF STAPHYLOCOCCAL INFECTIONS

Staphylococcal infections are a major clinical problem as they are associated with a high mortality rate. In this review we discuss the various antibiotics available for treating staphylococcal infections. Staphylococci induce infection either by direct invasion, resulting in skin and soft tissue infections, bacteraemia or endocarditis, or through the release of toxins, resulting in scalded skin syndrome, food poisoning or toxic shock syndrome. The development of resistance has limited the options available for treatment of staphylococcal infections. beta-Lactamase-resistant penicillins, such as nafcillin, oxacillin and flucloxacillin, are important for the treatment of methicillin-susceptible strains. For infections with methicillin-resistant strains, however, glycopeptides remain the drugs of choice. Wound, soft tissue and skin infections associated with Staphylococcus aureus can be treated orally with flucloxacillin or classical cephalosporins. Staphylococcus aureus endocarditis usually responds to parenteral treatment with a beta-lactam plus an aminoglycoside, although vancomycin remains the standard treatment for endocarditis caused by methicillin-resistant staphylococci. 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 joints or intravascular devices it is necessary to remove the device and initiate treatment with antistaphylococcal antibiotics. Treatment should be continued for up to 6 weeks if septicaemia and endocarditis are also present. Toxic shock syndrome caused by a toxin produced by Staphylococcus aureus responds to antistaphylococcal antibiotics and supportive treatment. Staphylococcal scalded skin syndrome occurs in neonates as a result of a Staphylococcus aureus exfoliatin. Treatment involves fluid replacement and antistaphylococcal antibiotics for up to 2 weeks. Future possible antimicrobials for staphylococcal infections include the new quinolones, which have shown increased activity against staphylococci and the streptogramins.