Antibiotics for staphylococcus aureus: indications for use

It just so happens that the world around us is inhabited not only by friendly creatures, and humans have many pests, most of which cannot even be seen without a microscope. We are talking about bacteria - the smallest microorganisms that find all the conditions for their development and reproduction in the human body. At the same time, staphylococcal infection is considered one of the most popular causes of various diseases. It is not without reason that almost all antimicrobial agents are designed to combat this particular bacterium. But when using antibiotics for staphylococcus, you need to remember that these ancient bacteria have learned to fight the drugs used against them in the process of evolution and have become more resistant to their effects.

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Indications antibiotics for staphylococcus aureus.

As we have already said, many narrow-target drugs and almost all broad-spectrum antibiotics can be successfully used to get rid of staphylococcus. But there is one nuance. Staphylococcal infection is a general term that unites several types of staphylococcus. Some of them are absolutely harmless, while other types can cause various diseases in humans.

In total, there are more than 50 types of staphylococcus today. Most of them live around us without causing any harm. More than 14 types of bacteria live on our skin and, if the immune system is functioning stably, also do not cause any diseases.

It should be said that most staphylococci can be confidently classified as non-pathogenic microorganisms. And only 4 varieties of this spherical bacterium claim to be classified as opportunistic microflora. These are the strains:

• Staphylococcus aureus (golden staphylococcus) is the most dangerous of all types of bacteria,
• Staphylococcus epidermidis (epidermal staphylococcus),
• Staphylococcus haemolyticus (hemolytic staphylococcus),
• Staphylococcus saprophyticus (saprophytic staphylococcus).

Staphylococcus aureus is a fairly common type of bacteria that can be found both in the soil or air, and on the surface of the skin and mucous membranes of a person. Activation of the microorganism occurs if the intestinal microflora is disturbed or general/local immunity is reduced.

Under suitable conditions, the pathogenicity of bacteria of this type is undeniable. They produce substances capable of destroying protein, leukocytes and erythrocytes of the human body, increasing the coagulability of blood plasma, synthesizing toxic substances that cause diarrhea and components that affect the skin. It is with this infection that multiple pathologies of the skin and subcutaneous tissue, inflammatory diseases of the respiratory system, brain, nervous, genitourinary and digestive systems, hearing and vision organs are associated. Staphylococcus aureus can cause inflammation of the tissues of the cardiovascular and musculoskeletal systems. Multiple food intoxications and toxic shock syndrome are associated with it.

Penetrating the body, the bacteria causes purulent-inflammatory processes that occur as abscesses. Moreover, Staphylococcus aureus itself is capable of destroying the cells of the immune system, weakening its work and creating favorable conditions for its further reproduction and generalization of the inflammatory process.

The most interesting thing is that infants have innate immunity to Staphylococcus aureus. Later, the body begins to produce antibodies to it, but as soon as the intestinal microflora is disrupted, the Staphylococcus aureus that has entered the body begins to show increased activity and reduces the work of the immune system to nothing.

Antimicrobial drugs are used to treat pathologies caused by Staphylococcus aureus. But the bacteria is so adapted to survive in unfavorable conditions that antibiotics do not always help against Staphylococcus. The resistance of this type of Staphylococcus to antibiotics makes it dangerous even in hospital settings. According to the WHO, Staphylococcus aureus is the main culprit of hospital-acquired infections.

Staphylococcus epidermidis is a representative of the microflora of our body, which is always present on the skin and mucous membranes. When it gets inside the body, it is attacked by the immune system, but unlike Staphylococcus aureus, it is not able to affect its work, therefore it is considered less dangerous.

But the fact that the bacterium settles on the skin makes it a treacherous enemy in medical institutions. Insufficient sterility of instruments and implants, failure to comply with hygiene and sanitation requirements lead to infection with opportunistic bacteria in people whose bodies are weakened by the disease. It is clear that the addition of staphylococcal infection leads to various types of inflammatory complications.

Hemolytic staphylococcus is a bacterium that causes the destruction of red blood cells under the influence of the toxins it produces. Its habitat is considered to be air and soil, although it can also be found on the skin in some quantities. Entering the body through the mouth, it most often causes sore throat and other types of tonsillitis. But its participation in the development of many skin, genitourinary and some other infections should not be ruled out.

This type of bacteria is also resistant to most antibiotics, which causes problems in the treatment of diseases caused by hemolytic staphylococcus.

Saprophytic staphylococcus chooses moist places in the genital folds and mucous membranes of the genitals for its habitat, and affects women more often than men, causing inflammatory pathologies of the genitourinary system. Most often, this is cystitis and urethritis, less often, kidney inflammation. This is the least common type of staphylococcus capable of causing diseases in humans, which is due to its preferences in terms of place of residence.

The bacteria is resistant to various environmental conditions, but is not able to withstand strong human immunity. Saprophytic staphylococcus is sensitive to most antibiotics. But if you do not take the treatment seriously or do not complete it, there is a chance that individual representatives of the bacterial saprophytic flora will survive and become more resistant to the drugs designed to fight them.

Staphylococcal infection is a general term that combines many different inflammatory pathologies localized in different parts of the body. Symptoms depend on how deeply the infection has penetrated, how actively it multiplies, and what the human immune system's capabilities are in fighting the pathogen.

When Amoxiclav and Summamed, which are very popular among doctors for their high efficiency in combating various types of bacterial infections, are prescribed to patients by specialists from different fields of medicine, patients have doubts: how can one drug treat completely different pathologies? It turns out that it can, and quite successfully.

The fact is that the same staphylococcus can cause many unrelated diseases, and the lesions can be located both inside and outside the body. Let's consider in what situations a general practitioner or specialist can prescribe antibiotics for staphylococcus, i.e. what diseases can be caused by staphylococcal infection.

Let's start with Staphylococcus aureus. It most often causes:

• inflammatory processes on the skin and in the subcutaneous tissue area, as a result of which the following are formed on the surface of the body:
  • boils (abscesses),
  • pyoderma (purulent inflammation of the skin),
  • sycosis (inflammation of the hair follicles in the area of the nose, eyebrows, scalp, moustache, pubis, armpits, etc.),
  • abscesses (purulent-necrotic changes in the skin and adipose tissue),
  • phlegmon (diffuse purulent inflammation of superficial and deeper tissues without defined boundaries),
  • pustules with purulent fluid inside (vesiculopustulosis),
  • panacirium or inflammation of the skin on the extreme phalanx of the finger,
  • scalded skin syndrome (exfoliative dermatitis or Ritter's disease), when the surface of the skin behaves as if it has been burned, first turning red and swollen, then cracks and blisters form on it, it begins to peel and acquires a purple hue.
• Lesions of the mucous membrane of the eye (staphylococcal conjunctivitis)
• Inflammation of bone and cartilage tissue (osteomyelitis, arthritis, etc.),
• Inflammatory processes in the nasopharynx (most often staphylococcal tonsillitis, which is difficult to treat with penicillin antibiotics, as well as rhinitis with purulent secretion, pharyngitis).
• Inflammatory processes in the lower respiratory tract (bronchitis, tracheitis, pleurisy, pneumonia, occurring with complications or against the background of other infectious pathologies, most often at high temperature).
• Inflammation of the heart tissue (damage to the inner lining of the heart and its valves due to infection entering through the bloodstream, resulting in heart failure).
• Acute toxic infections that cause inflammation of intestinal tissue (enteritis, enterocolitis) with fever, greenish stool, and frequent vomiting.
• Brain and CNS lesions (inflammation of the meninges and brain abscess).
• Inflammatory processes in the kidneys and urinary tract (cystitis, pyelonephritis, urethritis, etc.).
• Septic lesions (blood poisoning). Distinguish:
  • septicopyemia, when the infection spreads through the blood throughout the body and causes purulent lesions to appear in different places,
  • septicemia, in which the body becomes intoxicated with bacterial secretions (in severe cases, infectious toxic shock develops with a drop in blood pressure, loss of consciousness, and coma).

Hemolytic staphylococcus most often causes severe purulent tonsillitis, the treatment of which is difficult due to the high resistance of the pathogen to changing environmental conditions and the effects of antibiotics. Drugs for the treatment of tonsillitis caused by Staphylococcus haemolyticus are difficult to select, given the resistance of many of its strains to most antibiotics. But even in this case, it is not always possible to achieve complete irradiation of the pathogen. After a course of antibiotic treatment for staphylococcus, the bacterium can simply lie low and wait for the right moment to show itself again in all its "glory".

Not much less often, hemolytic staphylococcus causes skin and urogenital infections. It is often detected in pregnant women, whose bodies are weakened by working for two, in people with immunodeficiency, chronic diseases that drain a person's strength.

In principle, this type of bacteria is capable of causing all the pathologies that are characteristic of its golden relative. And the diseases in most cases will also proceed with an increase in temperature, enlarged lymph nodes, severe weakness and fatigue, as well as a high probability of complications in nearby organs.

Epidermal staphylococcus most often causes skin infections, so when purulent-inflammatory lesions of the skin and subcutaneous tissue develop, suspicion primarily falls on it, because it is this type of staphylococcal infection that is used to settling on the surface of the body. And we have become so accustomed to it that we do not even think about the possible consequences of traumatic damage to the skin or eating with unwashed hands, until the immune system fails and the opportunistic microorganism reminds us of itself with painful symptoms.

Yes, the fact that Staphylococcus epidermidis is used to living on the surface of the body does not mean that it cannot get inside orally, i.e. through the mouth, or by going deep into a wound on the skin. Thus, epidermal staphylococcus can cause intestinal infections and inflammatory processes of internal organs. But unlike hemolytic and golden types of bacteria, Staphylococcus epidermidis will not cause severe symptoms. In most cases, the disease is subacute without a strong increase in temperature, enlarged lymph nodes and other dangerous manifestations.

But the danger of epidermal staphylococcus is that it provokes a large number of hospital-acquired infections, causing suppuration in the area of catheter insertion and surgical interventions in which a skin incision is made, if the disinfection of instruments and skin was insufficient, or the patient himself introduced the infection into the wound with his hands.

However, an infection is an infection, and it will be difficult to get rid of it without antibiotics, especially if we are talking about inflammation of internal organs. And if with skin pathologies it is sometimes possible to get by with just the help of antiseptics used to cleanse the wound from bacteria, then with internal diseases such a practice does not work, which means that even for epidermal staphylococcus you have to take systemic antibiotics.

Saprophytic staphylococcus is associated mainly with diseases of the urinary system, although it can also be found in gynecological pathologies. Most often, saprophyticus is guilty of developing cystitis, urethritis and inflammatory pathologies of the male genital organ (balanitis, balanoposthitis). But even then, it is not thought of first, because the prevalence of the saprophytic type of staphylococcus is very low (about 5%).

The oral route of infection penetration into the body is irrelevant in this case. It is unlikely that anyone would eat food after visiting the toilet with unwashed hands. And diseases in children are not associated with Staphylococcus epidermidis at all.

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Release form

But let's return to our drugs, with the help of which doctors currently fight staphylococcal infection. If previously cephalosporins and penicillins were mainly prescribed, today other groups of antibiotics are also used in the treatment of staphylococcus: lincosamides, sulfonamide drugs, macrolides, fluoroquinolones (for purulent infections), modern antibiotics glycopeptides, etc.

But again, in mild cases of staphylococcal infection, penicillins are the first to be used, preferring their protected versions, and cephalosporins, always taking into account the type of pathogen.

Since the most common and dangerous pathogen of various internal and external inflammatory diseases is considered to be Staphylococcus aureus, it is worth starting a review of effective drugs for staphylococcal infection with it.

Antibiotics that kill Staphylococcus aureus include:

• protected and unprotected penicillins (Ampicillin, Benzylpenicillin, Amoxicillin, pure or in combination with clavulanic acid, Augmentin, Methicillin, Dicloxacillin, Flemoxin Solutab, etc.),
• 2-3 generation cephalosporins (Cefalexin, Ceftriaxone, Cefazolin, Cefuroxime, Ospexin, Flexin, etc.),
• macrolides (“Azithromycin”, “Sumamed”, “Clarithromycin”, “Oleandomycin”, etc.),
• lincosamides (“Clindamycin”, “Lincomycin”),
• fluoroquinolones (Ofloxacin, Moxifloxacin, etc.),
• aminoglycosides (Gentamicin),
• tetracyclines (“Doxycycline”),
• nitrofurans (Furazidin, Furamag, Nifuroxazide, etc.),
• carbapenems (Imipenem, Tienam),
• new antibiotics: glycopeptide "Vancomycin", oxazolidone "Linezolid", others - "Fuzidin" in combination with "Biseptol" (a drug from the sulfonamide group), etc.

The list of drugs effective against Staphylococcus aureus can be continued further, it is quite extensive. But this does not mean that drugs are prescribed with the same frequency. In most cases, they turn to protected penicillins (for example, "Augmentin"), "Methicillin" (although it does not have the same effectiveness as before, before the appearance of methicillin-resistant strains), cephalosporins (for example, "Cefuroxime").

Nitrofurans are prescribed mainly for staphylococcus in the intestines and urinary system. It makes sense to prescribe "Gentamicin" for hypersensitivity to beta-lactam drugs. And "Doxycycline", fluoroquinolones and new antibiotics are usually prescribed only in very severe cases of purulent inflammation.

When talking about the effectiveness of macrolides and lincosamides, we must not forget that these are drugs with a bacteriostatic effect that do not kill microorganisms, but inhibit their reproduction. To destroy the population of Staphylococcus aureus in the body, you need to take such drugs in large doses.

Fighting Staphylococcus aureus is not easy, since the bacteria constantly mutates to form new strains that are insensitive to traditional antibiotics. When strains resistant to beta-lactams appeared, a new drug of the penicillin series "Methicillin" was created. For a long time, it was considered the most effective against Staphylococcus aureus, but soon strains began to appear that were insensitive to this drug and causing both hospital and household infections.

Moreover, bacteria that are not sensitive to methicillin do not show sensitivity to various beta-lactams. In the treatment of infectious pathologies caused by resistant pathogens, antibiotics are used that act on methicillin-resistant strains of staphylococcus (Clindamycin, Spiromycin, Tetracycline, Doxycycline, Linezolid, etc.).

The fight against hemolytic streptococcus, which has developed "immunity" against most antibacterial drugs, is no easier. When prescribing antibiotics for hemolytic staphylococcus, it is necessary to take into account the results of the analysis of the pathogen and the resistance of the detected strain to the recommended drugs.

Hemolytic staphylococcus most often settles in the throat, causing tonsillitis (more commonly known as angina). And against angina, it is customary to prescribe antibiotics of the penicillin series, to which Staphylococcus haemolyticus has not shown much sensitivity for a long time, which is why there is no positive dynamics.

If penicillins are ineffective, cephalosporins are used, and if beta-lactams are intolerant, macrolides and lincosamides are used. If the disease is severe, it makes sense to try therapy with new antibiotics: Vancomycin in combination with Ciprofloxacin, Linezolid and other drugs.

It is important to understand that angina is not the only pathology caused by the hemolytic variety of staphylococci. And in each specific case, the doctor will have to develop a complex treatment regimen for the disease associated with a very tenacious pathogen. In the fight against hemolytic staphylococci, it is often necessary to use several antibiotics to finally exterminate this insidious parasite.

Although epidermal staphylococcus settles on the skin, it can also penetrate into the body, causing inflammatory processes there. Diseases caused by epidermal staphylococcus are milder than those caused by Staphylococcus aureus, because the strains of skin inhabitants cannot synthesize an enzyme that promotes increased blood clotting. And there are far fewer antibiotic-resistant strains of Staphylococcus epidermidis than other types of staphylococcus.

Most often, the following is prescribed for the treatment of epidermal staphylococcus:

• penicillins (“Amoxicillin”, “Amoxiclav”, “Methicillin”, etc.),
• cephalosporins (Ceftriaxone, Cefopirazone, Cefuroxime, etc.),
• macrolides (“Clarithromycin”, “Josamycin”, “Azithromycin”, etc.),
• nitrofurans (Nifuroxazide, Furazolidone, etc.),
• lincosamides (“Lincomycin”, “Clindamycin”),
• carbapenems (Imipenem, Tienam),
• new antibiotic "Rifaximin" and its analogue "AlphaNormix".

In severe infections, doctors may resort to fluoroquinolones. Strains sensitive to methicillin can be defeated with the drugs Levofloxacin and Moxifloxacin. For resistant strains, you can try using the fluoroquinolone Norfloxacin.

Since Staphylococcus epidermidis is capable of causing many diseases in the local environment, i.e. on the skin, to combat it, not only systemic but also local antibiotics in the form of ointments, creams, solutions are often used (Mupirocin, Bactroban, Altargo, Baneocin, Fuzidin, Chlorophyllipt, etc.).

Saprophytic staphylococcus is the rarest inhabitant of our body, which likes to settle in intimate places. To get rid of saprophytic staphylococcus, you can use any antibiotics that we wrote about above. The only thing that needs to be taken into account is the sensitivity of the identified strain of bacteria to the drugs that the doctor plans to use to treat urogenital infections caused by Staphylococcus saprophyticus.

Since staphylococcal infection can equally affect both adults and children, occurring with different localizations and severity, antibiotics are used for its treatment, the release form of which corresponds to the patient's condition and age. It is clear that we are talking about drugs with proven effectiveness against the identified type and strain of bacteria.

In most cases of treating patients over 3 years of age, antibiotics for staphylococcus are prescribed in the form of oral forms: regular tablets or coated tablets, which are considered safer in terms of irritating effects on the gastrointestinal tract. There are also drugs produced in the form of gelatin capsules, which contain medicinal powder. Capsules are also a kind of protection for the gastrointestinal mucosa.

Another form of antibiotics intended for oral administration is suspensions (powder or granules for its preparation are provided for "Amoxicillin", "Augmentin", "Amoxiclav", "Zinnat", "Cefalexin", "Sumamed", "Macropen", "Nifuroxazide" and some other antibiotics for staphylococcus). This form of medicine is usually used in the treatment of children under 6 years of age. It is more convenient to use for those who do not yet know how to swallow tablets, and in most cases it has a more pleasant taste and aroma.

If the disease is severe, so there is no time to wait for the medicine to travel all the way along the gastrointestinal tract and be absorbed in the intestines, from where it enters the blood, a more appropriate treatment would be injections and infusions of antibacterial drugs. Antibiotics for these purposes are mainly produced in the form of powder (lyophosylate), which is diluted with appropriate liquids before administration. For intramuscular administration, these can be anesthetics, and for intravenous administration, saline, injection solution, etc.

Most cephalosporins, some penicillins and macrolides, Vancomycin and some other drugs are produced in the form of powder for the preparation of solutions, placed in hermetically sealed vials.

But some drugs can also be produced as ready-made infusion solutions. Among the effective antibiotics produced as an infusion solution, fluoroquinolones "Moxifloxacin", "Ofloxacin", "Levofloxacin" (one of the few effective against saprophytic staphylococcus), antibiotics from the carbapenem group, for example, "Imipenem", and some other drugs can be used against staphylococcus.

Lincosamides are available in the form of tablets and ready-made injection solutions in ampoules. "Gentamicin" is produced both as a powder for the preparation of compositions for parenteral intramuscular administration, and as ready-made solutions used for intravenous and intramuscular injections. "Doxycycline" can be found on pharmacy shelves both in the form of capsules and in the form of lyophilisate for the preparation of infusion solutions for intramuscular systems.

The choice of the drug release form depends on the localization of the disease. If we are talking about damage to internal organs, drugs are prescribed in the form of tablets, capsules, suspensions, solutions for injections and infusions. Severe systemic lesions by staphylococcus are treated with injections and droppers (infusions), with a subsequent transition to parenteral forms.

But staphylococcal infection can multiply in the nose, throat, on the skin, causing purulent-inflammatory changes in the tissues at the site of settlement. In this case, the use of systemic antibiotics is enhanced by local action on the pathogen.

Antibiotics for staphylococcus in the nose for local use can be released in the following forms: aerosol (Bioparox, Anginal, Isofra, Polydexa, etc.), drops (Garazon, Fluimucil, etc.), ointments (Bactroban, Mupirocin, Baneocin, Altargo), and Chlorophyllipt solution.

If staphylococcus has settled in the ear or eyes, causing purulent inflammation, eye and ear drops are used (Tsipromed, Levomycetin, Signicef, Sofradex, Normax, Otofra, etc.).

Antibiotics for staphylococcus in the throat are basically the same as for the nose. You can use the above-mentioned aerosols to irrigate the mucous membrane in the tonsils and nasopharynx, gargle with Chlorophyllipt solution, use effective antiseptics active against staphylococcal infection in the form of sprays and solutions. Ointments in this case are inconvenient to use.

In case of staphylococcus in the throat, preference is given to systemic antibiotics, since the bacteria can easily spread from the throat throughout the body. Local treatment is considered additional and is used mainly for purulent tonsillitis.

Antibiotic for staphylococcus on the skin - most often it is a local drug in the form of an ointment, gel, solution. As an effective solution for staphylococcus, they use both the antibiotic "Chlorophyllipt" and conventional antiseptics - solutions of furacilin, potassium permanganate, brilliant green.

As for ointments, in this case the same preparations are applicable as for staphylococcus in the nose, which are used after treating the surface affected by the disease with an antiseptic.

As we can see, antibiotics for staphylococcus can have a variety of forms of release, which makes it possible to treat the infection even in the most hidden places of the body. The instructions for each drug have a section that explains how, with what solutions and in what proportions to dilute forms of antibiotics intended for intramuscular or intravenous administration (parenteral route), how to prepare a suspension for children and adults, how to take tablets and apply ointments in each specific case.

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