Antimicrobial Therapy

  • J. Carl Craft

Abstract

Cellulitis, infected wounds, abscesses, and other bacterial infections of skin and soft tissue account for a significant number of clinical visits to the dermatology, medicine, family practice, and pediatric clinics as well as emergency rooms worldwide. Before physicians in the many different countries can treat these infections, they must have a means of determining the causative bacteria. In the case of a primary bacterial infection produced by the invasion of normal skin by a single species of pathogenic bacteria, most infections will be due to Gram-positive organisms. Secondary infections develop in areas of already damaged skin and the infecting bacteria invasion and proliferation aggravate the underlying condition and prolong the disease. In contrast to the primary infections, secondary infections demonstrate multiple organisms including Gram-positive organisms, but Gram-negative organisms are not infrequently seen on culture. The majority of these infections are mild to moderate in severity and can be treated with either topical or oral medication. The etiological agents as shown in Table 45.1 vary little worldwide with Streptococcus pyogenes (Group A streptococcus) and Staphylococcus aureus accounting for greater than 90% of all skin infections. Even in those areas of the world where more exotic pathogens exist, the majority of infections are still caused by staphylococcus and streptococcus. This would suggest that treatment recommendations in any country would apply to all other countries.

Keywords

Penicillin Staphylococcus Acne Clostridium Fluoroquinolone 

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References

  1. 1.
    Galen W, Craft JC, Cohen I, et al: Bacterial disease. In: Schachner LA, Hansen RC, eds. Pediatric Dermatology, New York: Churchill Livingstone, 1988: 1261–1369.Google Scholar
  2. 2.
    Swartz MN: Skin and soft tissue infections—cel-lulitis and superficial infections. In: Mandell GL, Douglas RG, Jr, Bennett JE, eds. Principles and Practices of Infectious Diseases, 2nd ed. New York: John Wiley & Sons, Inc. 1985: 598–609.Google Scholar
  3. 3.
    Esposito AL, Adam D: Infection of skin and subcutaneous tissue. In: Eichenwald HF, Ströder 12. J, eds. Current Therapy in Pediatrics—2. New York: B.C. Decker, 1989: 698–704.Google Scholar
  4. 4.
    Parish LC, Witkowski JA: Systemic management of cutaneous bacterial infections. Am J Med 1991; 91 (6A): 106S - 110S.PubMedCrossRefGoogle Scholar
  5. 5.
    Powers RD: Soft tissue infections in the emergency department: the case for the use of “simple” antibiotics. South Med J 1991; 84 (11): 1313–1315.PubMedCrossRefGoogle Scholar
  6. 6.
    Idsoe O, et al: Nature and extent of penicillin side reactions with particular reference to fatalities from anaphylactic shock. Bull WHO 1968; 38: 159.PubMedGoogle Scholar
  7. 7.
    Sarna SK, Soergel KH, Koch TR, et al: Gastrointestinal motor effects of erythromycin in humans. Gastroenterology 1991; 101: 1488–1496.PubMedGoogle Scholar
  8. 8.
    Westh H, Jensen BL, Rosdahl VT, Prag J: Development of erythromycin-resistance in Staphylococcus aureus as a consequence of high erythromycin consumption. J Hasp Infect 1989; 14: 107.CrossRefGoogle Scholar
  9. 9.
    Appelbaum PC, Bhamjee A, Scragg JN, et al: Streptococcus pneumoniae resistant to penicillin and chloramphenicol. Lancet 1977; 2: 995–997.PubMedCrossRefGoogle Scholar
  10. 10.
    Nakanishi N, Yoshida S, Wakebe H, et al: Mechanisms of clinical resistance to fluoroquinolones in Staphylococcus aureus. Antimicrob Agents Chemother 1991; 35: 2562–2567.PubMedGoogle Scholar
  11. 11.
    Thomson KS, Sanders CC, Hayden ME: In vitro studies with five quinolones: evidence for changes in relative potency as quinolone resistance rises. Antimicrob Agents Chemother 1991; 35: 2329–2334.PubMedGoogle Scholar
  12. 12.
    Harnett N, Brown S, Krishnan C: Emergence of quinolone resistance among clinical isolates of methicillin-resistant Staphylococcus aureus in Ontario, Canada. Antimicrob Agents Chemother 1991; 35: 1911–1913.PubMedGoogle Scholar
  13. 13.
    George RC, Ball LC, Norbury PB: Susceptibility to ciprofloxacin of nosocomial gram-negative bacteria and staphylococci isolated in the UK. J Antimicrob Chemother 1990; 26 (suppl F): 145–156.PubMedGoogle Scholar
  14. 14.
    Kaatz GW, Seo SM, Ruble CA: Mechanisms of fluoroquinolone resistance in Staphylococcus aureus. J Infect Dis 1991; 163: 1080–1086.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag New York, Inc. 1994

Authors and Affiliations

  • J. Carl Craft

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