What is the treatment for Staphylococcus (Staph) infection?

From the Guidelines

Staph infections should be treated with a combination of incision and drainage, and antibiotic therapy, with the specific regimen depending on the severity and location of the infection, as well as the presence of methicillin-resistant Staphylococcus aureus (MRSA) 1. For cutaneous abscesses, incision and drainage is the primary treatment, and additional antibiotic therapy may be necessary for severe or extensive disease, or in the presence of associated cellulitis, signs and symptoms of systemic illness, or comorbidities 1. Some key points to consider when treating staph infections include:

• For outpatients with purulent cellulitis, empirical therapy for CA-MRSA is recommended pending culture results, with options including clindamycin, trimethoprim-sulfamethoxazole, a tetracycline, or linezolid 1.
• For outpatients with nonpurulent cellulitis, empirical therapy for infection due to b-hemolytic streptococci is recommended, with options including clindamycin alone, or trimethoprim-sulfamethoxazole or a tetracycline in combination with a b-lactam 1.
• For hospitalized patients with complicated SSTI, empirical therapy for MRSA should be considered pending culture data, with options including intravenous vancomycin, oral or intravenous linezolid, daptomycin, telavancin, or clindamycin 1. It's essential to note that cultures from abscesses and other purulent SSTIs are recommended in patients treated with antibiotic therapy, patients with severe local infection or signs of systemic illness, patients who have not responded adequately to initial treatment, and if there is concern for a cluster or outbreak 1. Proper wound care, including keeping the area clean, applying warm compresses to promote drainage, and covering wounds with clean bandages, is also crucial in the treatment of staph infections.

From the FDA Drug Label

The penicillinase-resistant penicillins are indicated in the treatment of infections caused by penicillinase-producing staphylococci which have demonstrated susceptibility to the drugs. The penicillinase-resistant penicillins may be used to initiate therapy in suspected cases of resistant staphylococcal infections prior to the availability of laboratory test results. In severe staphylococcal infections, therapy with penicillinase-resistant penicillins should be continued for at least 14 days. Therapy should be continued for at least 48 hours after the patient has become afebrile, asymptomatic, and cultures are negative.

Treatment of Staph Infection:

• Dicloxacillin is indicated for the treatment of infections caused by penicillinase-producing staphylococci.
• The drug should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria.
• The recommended dosage for dicloxacillin in mild to moderate and severe infections is as follows:
  • Adults: 125 mg every 6 hours for mild to moderate infections, and 250 mg every 6 hours for severe infections.
  • Children: 12.5 mg/kg/day in equally divided doses every 6 hours for mild to moderate infections, and 25 mg/kg/day in equally divided doses every 6 hours for severe infections.
• Therapy should be continued for at least 14 days in severe staphylococcal infections, and for at least 48 hours after the patient has become afebrile, asymptomatic, and cultures are negative 2, 2.

From the Research

Treatment Options for Staph Infections

• The treatment of staph infections, particularly those caused by methicillin-resistant Staphylococcus aureus (MRSA), is a complex issue due to the emergence of resistant strains 3, 4, 5, 6, 7.
• For methicillin-susceptible S. aureus (MSSA) infections, penicillinase-resistant penicillins such as flucloxacillin and dicloxacillin are the antibiotics of choice, while first-generation cephalosporins, clindamycin, lincomycin, and erythromycin may be used for less serious infections or in patients with penicillin hypersensitivity 3.
• For MRSA infections, vancomycin or teicoplanin are typically used for serious infections, while lincosamides, cotrimoxazole, or new antibiotics such as linezolid and quinupristin/dalfopristin may be used for less serious infections or in patients who are intolerant of conventional therapy 3, 4, 5.

Antibiotic Resistance and Treatment Challenges

• The emergence of MRSA has led to limited treatment options, and the use of oral antibiotics for less severe MRSA infections has not been well studied 4.
• MRSA isolates are often resistant to multiple antibiotics, making treatment challenging, and the use of combination therapy may be necessary to prevent the development of resistance 3, 5.
• New antibiotics such as linezolid, quinupristin/dalfopristin, and ceftaroline have shown promise in treating MRSA infections, but their use is often limited by cost and potential adverse effects 5, 6.

Clinical Considerations and Future Directions

• The treatment of staph infections requires careful consideration of the type of infection, potential adverse effects, and cost of treatment, as well as local antibiotic resistance patterns 4, 5, 6.
• Further research is needed to develop new antibiotics and to improve our understanding of the best treatment strategies for staph infections, particularly those caused by MRSA 4, 5, 7.