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Journal of Antimicrobial Chemotherapy (1999) 44, Topic A, 19-23
© 1999 The British Society for Antimicrobial Chemotherapy

Optimal treatment of complicated skin and skin structure infections

Ronald Lee Nichols*

Department of Surgery, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70112-2699, USA

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. aureuswith 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.

* Tel: +1-504-588-5168; Fax: +1-504-586-3843


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