Effects of a systemic antibiotic on nasal bacterial ecology in man

The nasal flora of coagulase-positive staphylococcus carriers and noncarriers was studied in aerobic conditions in 17 individuals. Five hundred milligrams of cephalexin was given orally four times daily for 12 days, and its effects on the nasal bacteria were determined quantitatively before, during, and after treatment. The total count obtained before the drug treatment was 5.4 x 10(6) in carriers and 3.9 x 10(6) in noncarriers. The lowest total count observed was 3 days after the cessation of the drug. The increase in gram-negative rods was seen 9 days after antibiotic therapy, not during the greatest reduction of gram-positive bacteria. Coagulase-positive cocci and diphtheroids were most sensitive to drug treatment. After 36 days, the total count was restored to pretreatment level. Diphtheroids did not return to the original number and were replaced by a corresponding increase of resistant coagulase-negative cocci. An inverse relationship between coagulase-negative cocci and lipophilic diphtheroids was seen in the anterior nares of many individuals. No gross difference in nasal ecology to differentiate carriers from noncarriers was seen.