Toxic Shock Syndrome Medication
- Author: Ramesh Venkataraman, MBBS; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, MCCM more...
The goals of pharmacotherapy are to reduce morbidity, prevent complications, and eradicate the infection. The FDA recently approved 3 new antibiotics, oritavancin (Orbactiv), dalbavancin (Dalvance), and tedizolid (Sivextro), for the treatment of acute bacterial skin and skin structure infections. These agents are active against Staphylococcus aureus (including methicillin-susceptible and methicillin-resistant S aureus [MSSA, MRSA] isolates), Streptococcus pyogenes, Streptococcus agalactiae, and Streptococcus anginosus group (includes Streptococcus anginosus, Streptococcus intermedius, and Streptococcus constellatus), among others. For complete drug information, including dosing, see the following monographs:
Antimicrobial therapy must cover all likely pathogens in the context of the clinical setting.
Clindamycin is a lincosamide indicated for serious skin and soft tissue staphylococcal infections. It is also effective against aerobic and anaerobic streptococci (except enterococci). As much as 20% of group B streptococci may be resistant. Clindamycin inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest.
Aqueous penicillin G interferes with the synthesis of cell wall mucopeptide during active multiplication, resulting in bactericidal activity against susceptible microorganisms.
Nafcillin is initial therapy for suspected penicillin G–resistant staphylococcal infections. Use parenteral therapy initially in severe infections. Owing to thrombophlebitis, particularly in elderly patients, administer parenterally only for the short term (1-2 d); change to oral route as clinically indicated.
Vancomycin is a potent antibiotic directed against gram-positive organisms and active against Enterococcus species. Vancomycin is useful in the treatment of patients with septicemia and skin structure infections. It is indicated for patients who cannot receive or have failed to respond to penicillins and cephalosporins or who have infections with resistant staphylococci (eg, MRSA). For abdominal penetrating injuries, combine with an agent active against enteric flora and/or anaerobes.
Use creatinine clearance to adjust dose in patients with renal impairment.
Oxacillin is a bactericidal antibiotic that inhibits cell wall synthesis. It is used in the treatment of infections caused by penicillinase-producing staphylococci. Oxacillin may be used to initiate therapy when staphylococcal infection is suspected.
Tedizolid is an oxazolidione antibiotic; its action is mediated by binding to the 50S subunit of the bacterial ribosome, resulting in inhibition of protein synthesis.
Oritavancin is a lipoglycopeptide antibiotic that exerts concentration-dependent bactericidal activity.
Dalbavancin is a lipoglycopeptide antibiotic; it interferes with cell wall synthesis by binding to D-alanyl-D-alanine terminus of the stem pentapeptide in nascent cell wall peptidoglycan, thus preventing cross-linking.
Dalbavancin is bactericidal in vitro against Staphylococcus aureus and Streptococcus pyogenes at concentrations observed in humans at recommended doses.
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