What is the recommended treatment for a patient with a heavy growth of Staphylococcus aureus in an oral throat wound culture?

From the Guidelines

For a patient with a heavy growth of Staphylococcus aureus in an oral throat wound culture, the recommended treatment is typically a course of antibiotics effective against S. aureus, with clindamycin 300-450 mg orally three times daily for 7-10 days being a suitable option, as it is effective against both S. aureus and b-hemolytic streptococci, as suggested by the guidelines from the Infectious Diseases Society of America 1.

The choice of antibiotic should be guided by susceptibility testing results when available, and in this case, the susceptibility testing shows that the S. aureus is susceptible to clindamycin, among other antibiotics.

• The patient's wound culture shows heavy growth of S. aureus, which is susceptible to clindamycin, making it a suitable treatment option.
• Clindamycin is effective against both S. aureus and b-hemolytic streptococci, making it a good choice for empirical therapy in cases where the infection is suspected to be caused by one of these pathogens.
• The guidelines from the Infectious Diseases Society of America recommend clindamycin as a first-line treatment option for skin and soft tissue infections caused by S. aureus, including those with suspected or confirmed MRSA 1.
• In addition to antibiotics, proper wound care including gentle cleansing with saline or antiseptic solutions and maintaining good oral hygiene is essential to prevent complications such as abscess formation or systemic infection.
• The patient's susceptibility testing results show that the S. aureus is susceptible to several antibiotics, including clindamycin, which makes it a suitable treatment option.
• The guidelines recommend that the choice of antibiotic should be guided by susceptibility testing results when available, and in this case, clindamycin is a suitable option based on the patient's susceptibility testing results 1.

From the FDA Drug Label

Oxacillin (cefoxitin)-susceptible staphylococci can be considered susceptible to: amoxicillin-clavulanate, ampicillin-sulbactam, piperacillin-tazobactam, ticarcillin-clavulanate, cefaclor, cefdinir, cephalexin, cefpodoxime, cefprozil, cefuroxime, loracarbef, cefamandole, cefazolin, cefepime, cefmetazole, cefonicid, cefoperazone, cefotaxime, cefotetan, ceftizoxime, ceftriaxone, cefuroxime, cephalothin, ceftaroline, moxalactam, doripenem, ertapenem, imipenem, meropenem. STAPHYLOCOCCUS AUREUS Drug MIC Interps CEFTAROLINE <=0.5 S CIPROFLOXACIN <=1 S CLINDAMYCIN <=0.5 S DAPTOMYCIN <=0.5 S ERYTHROMYCIN <=0.5 S GENTAMICIN <=4 S LEVOFLOXACIN <=1 S LINEZOLID 2 S OXACILLIN 0.5 S RIFAMPIN <=1 S TETRACYCLINE <=4 S TIGECYCLINE S TRIMETHOPRIM/SUL <=0.5/9.5 S VANCOMYCIN 1 S

The recommended treatment for a patient with a heavy growth of Staphylococcus aureus in an oral throat wound culture is antibiotics.

• The patient's isolate is susceptible to several antibiotics, including:
  • Ceftaroline
  • Ciprofloxacin
  • Clindamycin
  • Daptomycin 2
  • Vancomycin
• The choice of antibiotic should be based on the patient's specific situation and the susceptibility of the isolate.
• It is also important to note that Rifampin should not be used alone for antimicrobial therapy.
• Additionally, more than 90% of S. aureus are resistant to penicillin in the United States, so routine testing for penicillin is not always indicated.

From the Research

Treatment Options for Staphylococcus aureus Infections

• The patient has a heavy growth of Staphylococcus aureus in an oral throat wound culture, which is susceptible to several antibiotics, including ceftaroline, ciprofloxacin, clindamycin, daptomycin, erythromycin, gentamicin, levofloxacin, linezolid, oxacillin, rifampin, tetracycline, tigecycline, and vancomycin 3, 4.
• According to the study by 3, penicillinase-resistant penicillins, such as flucloxacillin and dicloxacillin, are the antibiotics of choice for the management of serious methicillin-susceptible S. aureus (MSSA) infections.
• For less serious MSSA infections, such as skin and soft tissue infections, first-generation cephalosporins, clindamycin, lincomycin, and erythromycin have important therapeutic roles 3.
• The study by 4 suggests that vancomycin is the most common drug used to treat severe MRSA infections, while other classes of antimicrobials, such as linezolid and quinupristin/dalfopristin, are also available to treat staphylococcal infections.
• Ciprofloxacin has been shown to be effective in treating S. aureus infections, but its use is limited due to the development of resistance 5.
• New antibiotics, such as linezolid, quinupristin-dalfopristin, and daptomycin, have been developed to treat severe staphylococcal infections, including those caused by MRSA 6.
• However, the increasing use of vancomycin has led to a decrease in its potency against S. aureus, including MRSA, and alternative treatment options are being explored 7.

Antibiotic Resistance and Treatment Considerations

• More than 90% of S. aureus strains are resistant to penicillin in the United States, making routine testing for penicillin resistance not always indicated 3.
• Methicillin-resistant S. aureus (MRSA) strains are resistant to nearly all β-lactam antimicrobials, and treatment options are limited to drugs such as vancomycin and linezolid 4.
• The development of vancomycin resistance among S. aureus strains is a concern, and alternative treatment options, such as combination therapy, are being explored 7.
• The choice of antibiotic therapy should be based on the susceptibility pattern of the isolated S. aureus strain, as well as the severity and location of the infection 3, 4.