TAILIEUCHUNG - Chapter 129. Staphylococcal Infections (Part 13)

Antimicrobial Therapy for Selected Settings For uncomplicated skin and soft tissue infections, the use of oral antistaphylococcal agents is usually successful. For other infections, parenteral therapy is indicated. S. aureus endocarditis is usually an acute, life-threatening infection. Thus prompt collection of blood for cultures must be followed immediately by empirical antimicrobial therapy. For S. aureus native-valve endocarditis, a combination of antimicrobial agents is often used. In a large prospective study, an SPRP combined with an aminoglycoside did not alter clinical outcome but did reduce the duration of S. aureus bacteremia. As a result, many clinicians begin therapy for life-threatening infections with. | Chapter 129. Staphylococcal Infections Part 13 Antimicrobial Therapy for Selected Settings For uncomplicated skin and soft tissue infections the use of oral antistaphylococcal agents is usually successful. For other infections parenteral therapy is indicated. S. aureus endocarditis is usually an acute life-threatening infection. Thus prompt collection of blood for cultures must be followed immediately by empirical antimicrobial therapy. For S. aureus native-valve endocarditis a combination of antimicrobial agents is often used. In a large prospective study an SPRP combined with an aminoglycoside did not alter clinical outcome but did reduce the duration of S. aureus bacteremia. As a result many clinicians begin therapy for life-threatening infections with a 3- to 5-day course of a 0-lactam and an aminoglycoside gentamicin 1 mg kg IV every 8 h . If a MRSA strain is isolated vancomycin 30 mg kg every 24 h given in two equal doses up to a total of 2 g is recommended. Patients are generally treated for 6 weeks. In prosthetic-valve endocarditis surgery in addition to antibiotic therapy is often necessary. The combination of a 0-lactam agent or if the isolate is 0-lactam-resistant vancomycin 30 mg kg every 24 h given in two equal doses up to a total of 2 g with an aminoglycoside gentamicin 1 mg kg IV every 8 h and rifampin 300 mg orally or IV every 8 h is recommended. This combination is used to avoid the possible emergence of rifampin resistance during therapy if only two drugs are used. For hematogenous osteomyelitis or septic arthritis in children a 4-week course of therapy is usually adequate. In adults treatment is often more prolonged. For chronic forms of osteomyelitis surgical debridement is necessary in combination with antimicrobial therapy. For joint infections a critical component of therapy is the repeated aspiration or arthroscopy of the affected joint to prevent damage from leukocytes. The combination of rifampin with ciprofloxacin has been used .

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