A 39-year-old man with a skin infection.
The case of Mr M, a previously healthy 39-year-old man with erythema and swelling of his finger, illustrates the issues involved in treating community-acquired skin and soft tissue infections since the emergence of methicillin-resistant Staphylococcus aureus (MRSA) in the community. Most community-acquired infections of the skin and soft tissues are caused by S aureus or Streptococcus pyogenes. Until recently, infections due to such organisms in the United States could safely be treated with an oral antistaphylococcal penicillin or an oral first-generation cephalosporin. However, the emergence of methicillin-resistant staphylococci as community-acquired pathogens has changed the picture as far as empirical therapy is concerned. Not only do community-acquired MRSA bacteria cause furunculitis and cellulitis, they have also been involved in a variety of more serious and life-threatening infections. Most of these organisms are susceptible to trimethoprim-sulfamethoxazole, minocycline, doxycycline, and rifampin, and these agents, along with clindamycin, have been used in the therapy of such infections, even though no clinical trials have proven their efficacy. For more serious, life-threatening infections, linezolid or parenteral agents such as vancomycin or daptomycin should be considered.
Moellering
Robert C
RC
Beth Israel Deaconess Medical Center, Department of Medicine, 110 Francis St, Ste 6A, Boston, MA 02215. rmoeller@bidmc.harvard.edu.
D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D002481:Cellulitis / Q000382:microbiology* / Q000628:therapy*; D017714:Community-Acquired Infections; D004322:Drainage; D024881:Drug Resistance, Bacterial; D004890:Erythema; D006801:Humans; D007249:Inflammation; D007262:Infusions, Intravenous; D008297:Male; D016106:Methicillin Resistance; D010406:Penicillins / Q000627:therapeutic use; D012008:Recurrence; D012307:Risk Factors; D017192:Skin Diseases, Bacterial / Q000175:diagnosis* / Q000628:therapy*; D013207:Staphylococcal Skin Infections / Q000175:diagnosis / Q000188:drug therapy; D013211:Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D010406:Penicillins; D015662:Trimethoprim, Sulfamethoxazole Drug Combination