Treatment of staphylococcal infection

Indications for hospitalization

Hospitalization is mandatory for patients with severe and moderate forms of the disease, including patients who cannot be isolated and properly cared for at home. The regimen depends on the clinical form of the disease. No diet is required.

Drug treatment of staph infection

Treatment of staphylococcal infection is carried out in four directions:

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

Etiotropic treatment of staphylococcal infection is carried out based on the results of antimicrobial susceptibility testing.

When isolating strains sensitive to methicillin, oxacillin and first-generation cephalosporins are used; when isolating resistant strains, vancomycin and penicillin preparations protected by beta-lactamase inhibitors (salbutamol, tazobactam, amoxicillin + clavulanic acid) are used. Rifampicin, linezolid, fusidic acid, clindamycin, fluoroquinolones (levofloxacin, pefloxacin, ofloxacin, ciprofloxacin) are also used. staphylococcal bacteriophage (locally, orally).

A prerequisite for effective treatment of staphylococcal infection is surgical sanitation of purulent foci (opening, evacuation of pus, excision of non-viable tissue, drainage).

Specific immunotherapy is carried out with antistaphylococcal immunoglobulin. Antialpha-staphylolysin is administered intramuscularly at a dose of 5 IU per 1 kg of body weight, 3-5 injections daily or every other day. In some cases, staphylococcal anatoxin, purified liquid, is administered subcutaneously in increasing doses: 0.1: 0.3: 0.5; 0.7: 0.9: 1.2; 1.5 ml every other day. Preparations of normal human immunoglobulin are also used, for example, normal human immunoglobulin for intravenous administration (pentaglobin; intraglobin; octagam; endobulin S/D). Levamisole, imunofan, and azoximer are used for immunostimulation.

Treatment of staphylococcal infection includes drainage of abscesses, excision of necrotic tissue, removal of foreign bodies (including vascular catheters), and administration of antibiotics. The choice and initial dose of antibiotics depend on the location of the infection, the severity of the disease, and the possibility of the presence of disease caused by resistant strains. Thus, knowledge of local resistance patterns is necessary to guide initial therapy.

Treatment of staphylococcal intoxications, the most serious of which is toxic shock syndrome, includes decontamination of the producing septic area (survey of surgical wounds, irrigation with antiseptic solutions, excision), intensive support (including vasopressors and respiratory support), normalization of electrolyte balance, and the use of antimicrobials. In vitro studies have shown a preferable role for protein synthesis inhibitors (eg, clindamycin 900 mg intravenously every 8 hours) over other classes of antibiotics. Intravenous immunoglobulin gives good results in acute cases.

Staphylococci are often resistant to antibiotics. Staphylococci often produce penicillinase, as well as an enzyme that inactivates several beta-lactam antibiotics. Most staphylococci are resistant to penicillin G, ampicillin, and antipseudomonal penicillins. Most community-acquired strains are susceptible to penicillinase-resistant penicillins (methicillin, oxacillin, nafcillin, cloxacillin, dicloxacillin), cephalosporins, carbapenems (imipenem, meropinem, ertapinem), macrolides, gentamicin, vancomycin, and teicoplanin.

Isolates of methicillin-resistant Staphylococcus aureus (MRSA) have become common, especially in hospitals. In addition, community-acquired methicillin-resistant Staphylococcus aureus (CMRSA) have emerged in recent years. CMRSA are less resistant to antibiotic polytherapy than hospital isolates. These strains are usually sensitive to trimethoprim-sulfamethoxazole, doxycycline, or minocycline. They are also often sensitive to clindamycin, but spontaneous resistance to clindamycin is possible in strains that have developed resistance to erythromycin. Vancomycin is effective against most hospital-acquired MRSA. In severe infections, vancomycin is effective with the addition of rifampin and an aminoglycoside. However, vancomycin-resistant strains have emerged in the United States.

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Antibiotics for Staph Infections in Adults

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Community-acquired skin infections (non-MRSA)

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

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Severe infections in which MRSA is questionable

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

Severe infections with a high probability of MRSA

• Vancomycin 15 mg/kg IV q12h or linezolid 600 mg IV q12h

Documented MRSA

• Based on sensitivity results

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Vancomycin-resistant staphylococci

• Linezolid 600 mg IV q12h, quinupristin plus dalfopristin 7.5 mg/kg q8h, daptomycin 4 mg/kg q24h

Outpatient observation

Dispensary observation of those who have recovered is not required.

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