THERAPY FOR STAPHYLOCOCCAL INFECTION

The penicillinase-stable penicillins and cephalosporins are the standard for antistaphylococcal therapy. Vancomycin is also currently the treatment of choice for infections with methicillin-resistant staphylococci. There is no clinical evidence that routine administration of a second agent with vancomycin will improve outcome. The most effective regimen for treatment of endocarditis remains to be defined. Teicoplanin may prove to be a satisfactory alternative to standard antistaphylococcal therapy in uncomplicated bacteremic infections. However, the correct dosage and efficacy of teicoplanin in deep-seated Staphylococcus aureus infections have not been established. The currently available quinolones are not, and should not be, utilized as first-line antistaphylococcal antibiotics. They have a role in certain types of mixed infection including S. aureus and may be appropriate therapy of staphylococcal infection in "problem" patients. General use of ciprofloxacin has been associated with the emergence of high-level resistance in methicillin-resistant S. aureus. For reasons that are not presently clear, most methicillin-susceptible S. aureus remain susceptible to ciprofloxacin. This situation must be carefully monitored as ciprofloxacin usage increases. The use of oral antibiotic regimens to eradicate S. aureus nasal carriage is often disappointing. The emergence of resistance has been a problem with ciprofloxacin-containing or rifampin-containing regimens. The topical agent, mupirocin, is promising in the therapy of the staphylococcal carrier. However, restraint must be used with mupirocin therapy in order to avoid the widespread emergence of resistance. New systems of bag change have been associated with a decreased incidence of peritonitis in continuous ambulatory peritoneal dialysis patients. Antibiotic bonding techniques may be valuable in prevention of intravenous catheter-associated infection.