From the Guidelines
For Staphylococcus (Staph) infections, the recommended antibiotic treatment is typically with agents effective against MRSA, such as clindamycin, TMP-SMX, doxycycline, or linezolid for outpatient treatment, and vancomycin, linezolid, daptomycin, or telavancin for inpatient treatment.
Key Considerations
- The choice of antibiotic depends on the severity of the infection, the presence of comorbidities, and the patient's clinical response.
- For outpatients with purulent cellulitis, empirical therapy for CA-MRSA is recommended pending culture results, with options including clindamycin, TMP-SMX, doxycycline, or linezolid 1.
- For outpatients with nonpurulent cellulitis, empirical therapy for infection due to b-hemolytic streptococci is recommended, with options including b-lactam antibiotics such as cephalexin or dicloxacillin, and consideration of clindamycin or linezolid for coverage of both streptococci and MRSA 1.
- For hospitalized patients with complicated SSTI, empirical therapy for MRSA should be considered pending culture data, with options including IV vancomycin, linezolid, daptomycin, telavancin, or clindamycin 1.
Specific Antibiotic Options
- Clindamycin: 300-450 mg PO TID for adults, 10-13 mg/kg/dose PO every 6-8 hours for pediatric patients 1.
- TMP-SMX: 1-2 DS tabs PO BID for adults, trimethoprim 4-6 mg/kg/dose, sulfamethoxazole 20-30 mg/kg/dose PO every 12 hours for pediatric patients 1.
- Doxycycline: 100 mg PO BID for adults, <45kg: 2 mg/kg/dose PO every 12 hours for pediatric patients 1.
- Linezolid: 600 mg PO/IV BID for adults, 10 mg/kg/dose PO/IV every 8 hours for pediatric patients 1.
Duration of Therapy
- 5-10 days of therapy is recommended for outpatients with SSTI, but should be individualized based on the patient's clinical response 1.
- 7-14 days of therapy is recommended for hospitalized patients with complicated SSTI, but should be individualized based on the patient's clinical response 1.
From the Research
Antibiotic Treatment for Staphylococcus Infections
The choice of antibiotic for Staphylococcus infections depends on the severity of the infection and the susceptibility of the strain to different antibiotics.
- For methicillin-susceptible Staphylococcus aureus (MSSA) infections, penicillinase-resistant penicillins such as flucloxacillin, dicloxacillin 2, or first-generation cephalosporins like cefazolin, cephalothin, and cephalexin are commonly used.
- For less serious MSSA infections, clindamycin, lincomycin, and erythromycin may also be effective 2.
- In cases of methicillin-resistant Staphylococcus aureus (MRSA) infections, parenteral vancomycin or teicoplanin are recommended for serious infections 2, 3.
- For community-acquired MRSA infections, lincosamides (clindamycin, lincomycin) or cotrimoxazole may be used for less serious infections such as skin and soft tissue infections 2.
- Newer antibiotics like linezolid, quinupristin/dalfopristin, and daptomycin have shown efficacy against MRSA infections, but their use is often reserved for patients who fail or are intolerant to conventional therapy 2, 4.
Specific Clinical Syndromes
The choice of antibiotic may also depend on the specific clinical syndrome:
- For skin and soft tissue infections, cephalosporins, oxacillin, or nafcillin may be used for MSSA, while vancomycin or linezolid may be used for MRSA 5.
- For bacteremia, endocarditis, and intravascular infections, vancomycin or daptomycin may be used for MRSA, while oxacillin or nafcillin may be used for MSSA 5.
- For pneumonia, linezolid or vancomycin may be used for MRSA, while cephalosporins or oxacillin may be used for MSSA 5, 4.
Historical Context
Historically, penicillin G was the most effective penicillin against non-penicillinase-producing staphylococci, while semisynthetic penicillins like methicillin, cloxacillin, nafcillin, and oxacillin were used for penicillinase-producing strains 6.