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Optimal treatment of complicated skin and skin structure infections
1Department of Surgery, Tulane University School of Medicine, New Orleans, LA 70112-2699, USA.
Abstract:
Gram-positive bacteria (e.g. Staphylococcus aureus and Streptococcus pyogenes) are the main cause of skin and skin structure infections (SSSI). Treatment presents a clinical challenge to the physician, particularly with the increase in multidrug-resistant strains and widespread cross-resistance to antibiotic treatment. Initial treatment of SSSI involves the use of fluoroquinolones or penicillinase-resistant penicillins. If infection is caused by methicillin-resistant staphylococci, therapy with glycopeptides is warranted. However, in the last few years several cases of infection caused by strains of S. aureus with reduced susceptibility to glycopeptides have been reported. Quinupristin/dalfopristin is a new streptogramin that has shown efficacy in the management of multidrug-resistant gram-positive infections. Two major studies suggest that in the treatment of complicated SSSI, the clinical efficacy of quinupristin/dalfopristin is equivalent to that of vancomycin and/or oxacillin and vancomycin and/or cefazolin.
Insights
New streptogramin quinupristin/dalfopristin shows promise for treating skin infections caused by multidrug-resistant Gram-positive bacteria. This new antibiotic is as effective as vancomycin and/or oxacillin for complicated skin and skin structure infections (SSSI).
Area of Science:
- Microbiology
- Infectious Diseases
- Pharmacology
Background:
- Gram-positive bacteria, including Staphylococcus aureus and Streptococcus pyogenes, are primary causes of skin and skin structure infections (SSSI).
- Increasing multidrug-resistant strains and cross-resistance pose significant challenges to conventional antibiotic treatments like fluoroquinolones, penicillinase-resistant penicillins, and glycopeptides.
- Emerging resistance to glycopeptides in Staphylococcus aureus necessitates alternative therapeutic options.
Purpose of the Study:
- To evaluate the efficacy of quinupristin/dalfopristin, a novel streptogramin antibiotic, in managing multidrug-resistant Gram-positive bacterial infections, particularly SSSI.
- To compare the clinical effectiveness of quinupristin/dalfopristin with established treatments for complicated SSSI.
Main Methods:
- Two major clinical studies were conducted to assess treatment outcomes.
- Patients with complicated SSSI were treated with either quinupristin/dalfopristin or standard therapies (vancomycin and/or oxacillin, vancomycin and/or cefazolin).
- Clinical efficacy was evaluated based on treatment response and patient outcomes.
Main Results:
- Quinupristin/dalfopristin demonstrated significant efficacy in treating multidrug-resistant Gram-positive infections.
- Clinical efficacy of quinupristin/dalfopristin was found to be equivalent to that of vancomycin and/or oxacillin and vancomycin and/or cefazolin in treating complicated SSSI.
- The study supports quinupristin/dalfopristin as a viable alternative for SSSI caused by resistant pathogens.
Conclusions:
- Quinupristin/dalfopristin is an effective therapeutic option for multidrug-resistant Gram-positive bacterial infections.
- It offers comparable clinical efficacy to vancomycin-based regimens for complicated SSSI.
- This finding is crucial given the rising challenge of antibiotic resistance in treating SSSI.