Treatment of staphylococcal infection

Indications for hospitalization

Hospitalization is mandatory for patients with a severe and moderate form of the disease, including patients who can not provide isolation and proper care at home. The regime depends on the clinical form of the disease. Diet is not required.

Drug treatment of staphylococcal infection

Treatment of staphylococcal infection is carried out in four directions:

• etiotropic therapy;
• sanation of foci of infection;
• immunotherapy;
• pathogenetic therapy.

Etiotropic treatment of staphylococcal infection is carried out, based on the results of testing sensitivity to antimicrobial agents.

When isolating strains sensitive to methicillin, use oxacillin, cephalosporins of the first generation; when isolating resistant strains - vancomycin, penicillin preparations. Protected by inhibitors of beta-lactamases (salbutamol, tazobactam, amoxicillin + clavulanic acid). Rifampicin, linezolid, fusidic acid, clindamycin, fluoroquinolones (levofloxacin, pefloxacin, ofloxacin, ciprofloxacin) are also used. Staphylococcal bacteriophage (topically, orally).

An obligatory condition for effective treatment of staphylococcal infection is surgical sanitation of purulent foci (autopsy, evacuation of pus, excision of nonviable tissues, drainage).

Specific immunotherapy is carried out with antistaphylococcal immunoglobulin. Enter intramuscularly at a dose of 5 ME per 1 kg of body weight antialpha-staphylolysin, 3-5 injections daily or every other day. In some cases, injected subcutaneously in increasing doses: 0.1: 0.3: 0.5; 0.7: 0.9: 1.2; 1.5 ml every other day, staphylococcal anatoxin, purified liquid. Also used are preparations of normal human immunoglobulin, for example, normal human immunoglobulin for intravenous administration (pentaglobin; intraglobin; octagam; endobulin S / D). For immunostimulation use levamisole, imunofan, azoxime.

Treatment of staphylococcal infection includes drainage of abscesses, excision of necrotic tissues, removal of foreign bodies (including vascular catheters), and administration of antibiotics. The choice and initial dose of antibiotics depend on the localization of the infectious process, the severity of the disease, and on the possibility of having a disease caused by resistant strains. Thus, it is necessary to know the local resistance patterns for initial therapy.

Treatment of staphylococcal intoxications, the most serious of which is an infectious-toxic shock, includes decontamination of the producing septic region (examination of surgical wounds, irrigation with antiseptic solutions, excision), intensive support (including vasopressors and respiratory support), normalization of electrolyte balance and use of antimicrobial agents. In vitro, a more preferred role of protein synthesis inhibitors (eg, clindamycin 900 mg intravenously every 8 hours) has been demonstrated in front of other classes of antibiotics. Intravenous immunoglobulin administration gives good results in acute cases.

Amongst staphylococci, resistance to antibiotics is frequent. Staphylococci often produce penicillinase, as well as an enzyme that inactivates several beta-lactam antibiotics. The majority of staphylococci are resistant to penicillin G, ampicillin and antipseudomonas penicillins. The majority of community-acquired strains are sensitive to penicillin-insulating penicillins (methicillin, oxacillin, nafcillin, cloxacillin, dicloxacillin), cephalosporins, carbapenems (imipinem, meropin, ertapine), macrolides, gentamicin, vancomycin and teicoplanin.

Isolates of methicillin-resistant Staphylococcus aureus (MRSA) have become frequent, especially in hospitals. In addition, out-of-hospital methicillin-resistant staphylococcus aureus (BMP) appeared in the last few years. BMPVs are less resistant to polytherapy with antibiotics than hospital isolates. These strains are usually sensitive to crametoprim-sulfamethoxazole, doxycycline or minocycline. They are also often sensitive to clindamycin, but there is the possibility of spontaneous resistance to it in strains that have developed resistance to erythromycin. Vancomycin is effective in most hospital MRSA. In severe infections, vancomycin is effective with the addition of rifampicin and aminoglycoside. Whatever it was, vancomycin-resistant strains appeared in the United States.

[1], [2], [3], [4], [5], [6], [7],

Antibiotics for Staphylococcal Infections in Adults

[8], [9], [10], [11]

Community-acquired skin infections (not MRSA)

• Dicloxacillin or cephalexin 250-500 mg orally after 6 hours 7-10 days
• In patients with penicillin allergy, erythromycin 250-500 mg orally after 6 hours, clarithromycin 500 mg orally after 12 hours, azithromycin 500 mg orally on the first day, then 250 mg orally after 24 hours or clindamycin 300 mg after 8 hours

[12], [13], [14], [15], [16]

Severe infections in which MRSA is questionable    

• Nafcillin or oxacillin 1-2 g intravenously after 4-6 hours or cefazolin 1 g IV after 8 hours
• In patients with penicillin allergy, clindamycin 600 mg IV after 8 hours or vancomycin 15 mg / kg after 12 hours

Severe infections with a high probability of MRSA    

• Vancomycin 15 mg / kg IV after 12 hours or linezolid 600 mg IV after 12 hours

Documented MRSA    

• According to the results of sensitivity

[17], [18], [19], [20], [21]

Vancomycin-resistant staphylococci    

• Linezolid 600 mg IV after 12 hours, quinupristin plus delfopristin 7.5 mg / kg after 8 hours, daptomycin 4 mg / kg after 24 hours

Dispensary supervision

Clinical follow-up for those who have recovered from illness is not required.

[22], [23], [24]