How do you treat Staphylococcus (Staph) epidermidis (Epi) folliculitis?

From the Guidelines

Staphylococcus epidermidis folliculitis is typically treated with topical antibiotics as first-line therapy, with mupirocin 2% ointment being a recommended option, as stated in the guidelines by the Infectious Diseases Society of America 1. For mild cases, apply mupirocin 2% ointment (Bactroban) to affected areas three times daily for 7-10 days. Alternatively, clindamycin 1% solution or benzoyl peroxide 5-10% wash can be effective. For more extensive or resistant cases, oral antibiotics may be necessary, such as cephalexin (500 mg four times daily), dicloxacillin (500 mg four times daily), or doxycycline (100 mg twice daily) for 7-10 days, as suggested by the 2014 practice guidelines for the diagnosis and management of skin and soft tissue infections 1. During treatment, maintain good hygiene by gently washing affected areas with antibacterial soap, avoiding harsh scrubbing, and using clean towels and clothing. Hot compresses applied to the affected follicles for 15-20 minutes several times daily can help drain pustules. S. epidermidis is a common skin commensal that typically causes mild infections when it enters hair follicles through minor breaks in the skin barrier. While generally less aggressive than S. aureus infections, proper treatment is important to prevent spread and recurrence. If symptoms worsen or don't improve within 3-5 days of treatment, seek medical attention as culture and sensitivity testing may be needed to guide antibiotic selection, as recommended by the 2018 WSES/SIS-E consensus conference 1.

Some key points to consider in the treatment of Staphylococcus epidermidis folliculitis include:

• The use of topical antibiotics as first-line therapy, with mupirocin 2% ointment being a recommended option 1.
• The importance of maintaining good hygiene and avoiding harsh scrubbing to prevent further irritation and infection.
• The potential need for oral antibiotics in more extensive or resistant cases, with options including cephalexin, dicloxacillin, and doxycycline 1.
• The importance of seeking medical attention if symptoms worsen or do not improve within 3-5 days of treatment, as culture and sensitivity testing may be needed to guide antibiotic selection 1.

It is also important to note that the treatment of Staphylococcus epidermidis folliculitis may vary depending on the severity of the infection and the individual patient's circumstances, and that the guidelines and recommendations provided are based on the available evidence and expert opinion 1.

From the FDA Drug Label

Mupirocin is active against a wide range of gram-positive bacteria including methicillin-resistant Staphylococcus aureus (MRSA). Mupirocin is active against most strains of Staphylococcus epidermidis and Staphylococcus saprophyticus.

The treatment for Staphylococcus epidermidis (Epi) folliculitis is likely topical mupirocin due to its activity against Staphylococcus epidermidis 2.

• Mupirocin has been shown to be bactericidal at concentrations achieved by topical administration.
• It is essential to note that the minimum bactericidal concentration (MBC) against relevant pathogens is generally eight-fold to thirty-fold higher than the minimum inhibitory concentration (MIC).

From the Research

Treatment Options for Staphylococcus Epidermidis Folliculitis

• The treatment of Staphylococcus epidermidis folliculitis typically involves the use of antibiotics, due to their anti-inflammatory and antimicrobial properties 3.
• Topical fusidic acid is widely used as an adjuvant treatment, and oral fusidic acid has also shown good results in some cases 3.
• Other treatment options include oral isotretinoin, which has been shown to be effective in achieving long-term remission in patients with folliculitis decalvans 4.
• Systemic antibiotics, such as cefadroxil, flucloxacillin, and azithromycin, may also be used to treat bacterial folliculitis and boils, although the evidence for their effectiveness is limited 5.
• The choice of antibiotic should be guided by the severity of the infection, local susceptibility patterns, and drug-related safety, tolerability, and cost 6.

Considerations for Treatment

• Bacterial wound cultures are important for characterizing local susceptibility patterns and guiding definitive antibiotic therapy 6.
• Response to therapy is expected within the first few days, and 5 to 7 days of therapy is typically adequate to achieve cure 6.
• The treatment of folliculitis should also take into account the anatomical location and histopathologic patterns of the condition, as well as the presence of any underlying conditions or predisposing factors 7.

Efficacy of Different Treatments

• Oral isotretinoin has been shown to be effective in achieving long-term remission in patients with folliculitis decalvans, with a success rate of 90% 4.
• Fusidic acid has been shown to be useful in the treatment of skin and soft tissue infections, particularly those due to Staphylococcus aureus 3.
• The efficacy of different systemic antibiotics, such as cefadroxil and flucloxacillin, is limited by the availability of high-quality evidence 5.