Skin and soft tissue infections: pharmacologic approaches

Skin and soft tissue infections are common infectious problems in pediatric practice. Recent clinical and pharmacologic evaluations of several new antimicrobial agents have shed new light on the pathogenesis and management of these infections. Staphylococcus aureus now appears to be the most common bacterial isolate in children with impetigo. In patients hospitalized because of skin and soft tissue infections, S. aureus and Haemophilus influenzae type b remain the predominant pathogens. Rational therapeutic approaches to these infections require a recognition of the interplay among the pharmacodynamic, pharmaceutic and pharmacokinetic determinants of effective antimicrobial therapy. Using this approach the therapeutic questions regarding "what drug," "what dose" and "how long to treat" can be approached. Drugs such as the aminopenicillin-beta-lactamase inhibitor combinations may offer rational outpatient therapeutic alternatives, while parenteral cefuroxime and ceftriaxone are more probably the drugs of choice for parenteral therapy. In an age when cost effectiveness must prevail, strategies using ceftriaxone for both inpatient and outpatient management may provide the safest and most cost-effective therapy.