From the Guidelines
For the treatment of Staphylococcus species infections, including methicillin-resistant Staphylococcus aureus (MRSA), the recommended oral antibiotics include trimethoprim-sulfamethoxazole (1-2 double-strength tablets twice daily), doxycycline (100 mg twice daily), or linezolid (600 mg twice daily) 1. The choice of antibiotic depends on the specific Staphylococcus species, local resistance patterns, infection severity, patient allergies, and comorbidities. Some key points to consider when selecting an antibiotic for Staphylococcus species infections include:
- The use of fluoroquinolones like levofloxacin or ciprofloxacin is generally avoided due to increasing resistance.
- For severe infections, initial intravenous therapy followed by oral antibiotics may be necessary.
- These antibiotics work by disrupting bacterial cell wall synthesis or protein production, preventing bacterial growth and reproduction.
- It is essential to complete the full course of antibiotics even if symptoms improve to prevent resistance development. In addition to these considerations, the following oral antibiotics are effective against Staphylococcus species infections:
- Dicloxacillin (500 mg four times daily)
- Cephalexin (500 mg four times daily)
- Clindamycin (300-450 mg three times daily) for 7-10 days for uncomplicated infections. It is crucial to note that the treatment guidelines may vary depending on the specific clinical scenario and the presence of any underlying conditions. Always consult the most recent and relevant clinical guidelines, such as those from the Infectious Diseases Society of America, for the latest recommendations on the diagnosis and management of skin and soft tissue infections, including those caused by Staphylococcus species 1.
From the FDA Drug Label
Clindamycin has been shown to be active against most of the isolates of the following microorganisms, both in vitro and in clinical infections [see Indications and Usage (1)]: Gram-positive bacteria Staphylococcus aureus (methicillin-susceptible strains) Streptococcus pneumoniae (penicillin-susceptible strains) Streptococcus pyogenes Anaerobic bacteria Clostridium perfringens Fusobacterium necrophorum Fusobacterium nucleatum Peptostreptococcus anaerobius Prevotella melaninogenica
The PO antibiotic that covers Staph spp is clindamycin (PO), specifically against Staphylococcus aureus (methicillin-susceptible strains) and Staphylococcus epidermidis (methicillin-susceptible strains) 2.
- Key points:
- Clindamycin is effective against methicillin-susceptible strains of Staphylococcus.
- Clindamycin is bacteriostatic and inhibits bacterial protein synthesis.
- Resistance to clindamycin can occur, and macrolide-resistant isolates of staphylococci should be screened for induction of clindamycin resistance using the D-zone test.
From the Research
PO Antibiotic Options for Staphylococcus spp.
The following PO antibiotics are effective against Staphylococcus spp.:
- Cephalexin 3
- Dicloxacillin 4, 3, 5
- Clindamycin 4, 6
- Lincomycin 4, 5
- Erythromycin 4, 5
- Minocycline 6
- Doxycycline 6
- Trimethoprim-sulfamethoxazole 6, 7
Specific Considerations
When choosing a PO antibiotic for Staphylococcus spp., consider the following:
- For methicillin-susceptible Staphylococcus aureus (MSSA), penicillinase-resistant penicillins (e.g., dicloxacillin) or first-generation cephalosporins (e.g., cephalexin) are effective 4, 3, 7
- For methicillin-resistant Staphylococcus aureus (MRSA), consider clindamycin, lincomycin, or minocycline 4, 6, 7
- For community-acquired MRSA, minocycline may be a preferred option 6