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Staphylococcus Aureus Infection Medication

  • Author: Elizabeth P Baorto, MD, MPH; Chief Editor: Russell W Steele, MD  more...
 
Updated: Jun 30, 2016
 

Medication Summary

The major antibiotics active against the staphylococcal organism are presented below.[132, 133]

A human chimeric monoclonal antilipoteichoic acid antibody (pagibaximab) has shown encouraging results for the prevention of staphylococcal infection in premature newborns in a phase 2 randomized, controlled trial.[134]

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Antistaphylococcal Antibiotics

Class Summary

Serious staphylococcal infections require treatment with parenteral penicillinase-resistant penicillin (eg, nafcillin, oxacillin) or first-generation or second-generation cephalosporins (eg, cephalexin, cefuroxime) plus clindamycin. Vancomycin is reserved for staphylococcal strains that are resistant to penicillinase-resistant penicillins (ie, MRSA) and clindamycin, or for when the patient has potentially life-threatening infection or intoxication. In these situations, minimum inhibitory concentrations of vancomycin should be monitored.[135, 136, 137, 138, 139, 140, 141]

Data for use of daptomycin in pediatrics are accruing. Linezolid is an alternative to vancomycin,[142, 143] although resistance has begun to appear.[144, 145] Tedizolid, an oxazolidinone, was approved by the FDA in June 2014 for adults. Approval for tedizolid was based on 2 clinical trials that included more than 1300 participants and showed it to be equivalent to linezolid.[146, 147, 148, 149, 150] Telavancin is a lipoglycopeptide derivative of vancomycin for use in complicated skin and skin-structure infections and pneumonia.[132, 151] Newer derivatives include dalbavancin and oritavancin (both FDA approved for adults).[152, 153] Ceftaroline is a broad-spectrum cephalosporin with activity against MRSA that is in clinical trials.[154, 155, 156, 157, 158]

An old antibiotic, fusidic acid, is receiving renewed attention in the United States for treatment of MRSA infections.[159, 160, 161] Topical antibiotics such as mupirocin or retapamulin may be used for superficial localized infections (ie, impetigo), although development of resistance may limit their utility.[162]

Telavancin (Vibativ)

 

Lipoglycopeptide antibiotic that is a synthetic derivative of vancomycin. Inhibits bacterial cell wall synthesis by interfering with polymerization and cross-linking of peptidoglycan. Unlike vancomycin, telavancin also depolarizes the bacterial cell membrane and disrupts its functional integrity. Indicated for complicated skin and skin structure infections caused by susceptible gram-positive bacteria, including S aureus (both methicillin-resistant and methicillin-susceptible strains), S pyogenes, S agalactiae, S anginosus group, and E faecalis (vancomycin-susceptible isolates only).

Dicloxacillin

 

Binds to one or more penicillin-binding proteins, which, in turn, inhibits synthesis of bacterial cell walls. For treatment of infections caused by penicillinase-producing staphylococci. May be used to initiate therapy when staphylococcal infection is suspected.

Oxacillin (Bactocill)

 

Bactericidal antibiotic that inhibits cell wall synthesis. Used in the treatment of infections caused by penicillinase-producing staphylococci.

Nafcillin (Nallpen)

 

Initial therapy for suspected penicillin G–resistant staphylococcal infections. Use parenteral therapy initially in severe infections. Change to PO therapy as condition warrants.

Amoxicillin and clavulanate (Augmentin)

 

Drug combination treats bacteria resistant to beta-lactam antibiotics. For children >3 mo, base dosage regimen on amoxicillin content. Because of different amoxicillin/clavulanic acid ratios in 250-mg tab (ie, 250/125) versus 250-mg chewable tab (ie, 250/62.5), do not use 250-mg tab until child is >40 kg.

Vancomycin (Vancocin)

 

Potent antibiotic directed against gram-positive organisms and active against Enterococcus species. Useful in the treatment of septicemia and skin structure infections. Indicated in patients who are unable to receive or who have not responded to penicillins and cephalosporins or for infections with resistant staphylococci. Use CrCl to adjust dose in patients diagnosed with renal impairment.

Clindamycin (Cleocin)

 

Lincosamide for treatment of serious skin and soft tissue staphylococcal infections. Also effective against aerobic and anaerobic streptococci (except enterococci). Inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, arresting RNA-dependent protein synthesis.

Daptomycin (Cubicin)

 

First of new antibiotic class termed cyclic lipopeptides. Binds to bacterial membranes and causes rapid membrane potential depolarization, thereby inhibiting protein, DNA, and RNA synthesis, and, ultimately, causing cell death. Indicated to treat complicated skin and skin structure infections caused by S aureus (including methicillin-resistant strains), S pyogenes, S agalactiae, S dysgalactiae, and E faecalis (vancomycin-susceptible strains only). Indicated for skin and skin structure infections.

Linezolid (Zyvox)

 

Prevents formation of functional 70S initiation complex, which is essential for bacterial translation process. Bacteriostatic against staphylococci.

The FDA warns against the concurrent use of linezolid with serotonergic psychiatric drugs, unless indicated for life-threatening or urgent conditions. Linezolid may increase serotonin CNS levels as a result of MAO-A inhibition, increasing the risk of serotonin syndrome.

Tedizolid (Sivextro)

 

Not approved for children. Tedizolid is an oxazolidinone antibiotic indicated for skin and skin structure infections caused by susceptible isolates of Gram-positive bacteria including Staphylococcus aureus (including methicillin-resistant [MRSA] and methicillin-susceptible [MSSA] isolates), Streptococcus pyogenes, S agalactiae, S anginosus Group (including S anginosus, S intermedius, and S constellatus), and Enterococcus faecalis. Its action is mediated by binding to the 50S subunit of the bacterial ribosome resulting in inhibition of protein synthesis.

Dalbavancin (Dalvance)

 

Not approved for children. Dalbavancin is lipoglycopeptide antibiotic that prevents cross-linking by interfering with cell wall synthesis. It is bactericidal in vitro against S aureus and S pyogenes at concentrations observed in humans at recommended doses. It is indicated for treatment of acute bacterial skin and skin structure infections caused by Gram-positive bacteria including S aureus (including methicillin-susceptible and methicillin-resistant S aureus [MRSA]), S pyogenes, Streptococcus agalactiae, and the Streptococcus anginosus group (including S anginosus, S intermedius, S constellatus).

Rifampin (Rifadin injection/oral, Rimactane oral)

 

Inhibits RNA synthesis in bacteria by binding to beta subunit of DNA-dependent RNA polymerase, which, in turn, blocks RNA transcription.

Sulfamethoxazole and trimethoprim (Bactrim, Septra)

 

Inhibits bacterial growth by inhibiting synthesis of dihydrofolic acid.

Mupirocin (Bactroban)

 

For elimination of S aureus. Inhibits bacterial growth by inhibiting RNA and protein synthesis.

Retapamulin (Altabax)

 

Topical antibiotic available as a 1% ointment. First of new antibiotic class called pleuromutilins. Inhibits protein synthesis by binding to 50S subunit on ribosome. Indicated for impetigo caused by Staphylococcus aureus or Streptococcus pyogenes.

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Cephalosporins

Class Summary

Newer beta-lactam cephalosporins have improved activity against aerobic and anaerobic gram-positive and aerobic gram-negative bacteria, including MRSA.

Ceftaroline (Teflaro)

 

Beta-lactam cephalosporin with activity against aerobic and anaerobic gram-positive and aerobic gram-negative bacteria. Demonstrates activity in vivo against resistant methicillin-resistant Staphylococcus aureus (MRSA) strains and in vitro against vancomycin-resistant and linezolid-resistant S aureus.

It is indicated in adults and children aged ≥2 months for treatment of acute bacterial skin and skin structure infections (ABSSSI) caused by susceptible isolates of: Staphylococcus aureus (including methicillin-susceptible and -resistant isolates), Streptococcus pyogenes, Streptococcus agalactiae, Escherichia coli, Klebsiella pneumoniae, and Klebsiella oxytoca. It is also indicated for community-acquired bacterial pneumonia caused by Staphylococcus aureus (methicillin-susceptible isolates only).

Cephalexin (Keflex)

 

First-generation cephalosporin that arrests bacterial growth by inhibiting bacterial cell wall synthesis. Bactericidal activity against rapidly growing organisms. Primary activity against skin flora.

Cefuroxime (Ceftin oral, Zinacef injection)

 

Broad-spectrum cephalosporin most closely resembling the second-generation cephalosporins. Cefuroxime is stable against beta-lactamase–producing organisms.

Cefazolin (Kefzol)

 

First-generation semisynthetic cephalosporin that arrests bacterial cell wall synthesis, inhibiting bacterial growth. Primarily active against skin flora, including S aureus. Typically used alone for skin and skin structure coverage.

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Blood Products

Class Summary

These agents stimulate an immune response and offer transient protection while the host immune system develops antibodies.

Immune globulin, intravenous (Carimune, Gammagard S/D, Gamunex)

 

Actions include neutralizing circulating myelin antibodies through anti-idiotypic antibodies, down-regulating proinflammatory cytokines (including interferon gamma), blocking Fc receptors on macrophages, suppressing inducer T and B cells, and augmenting suppressor T cells. Also blocks the complement cascade and promotes remyelination. May increase CSF IgG (10%).

IVIG has been shown to have high concentration of TSST-1 and the staphylococcal enterotoxins implicated in the pathogenesis of TSS. These antibodies may interfere with the binding of toxins that cause TSS.

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Contributor Information and Disclosures
Author

Elizabeth P Baorto, MD, MPH Director, Division of Pediatric Infectious Diseases, Atlantic Health System

Disclosure: Nothing to disclose.

Coauthor(s)

David Baorto, MD, PhD Medical Knowledge Engineer, Department of Medical Informatics, Columbia University Medical Center

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Larry I Lutwick, MD Professor of Medicine, State University of New York Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus

Larry I Lutwick, MD is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

José Rafael Romero, MD Director of Pediatric Infectious Diseases Fellowship Program, Associate Professor, Department of Pediatrics, Combined Division of Pediatric Infectious Diseases, Creighton University/University of Nebraska Medical Center

José Rafael Romero, MD is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, New York Academy of Sciences, Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

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Posteroanterior chest radiograph of a 15-year-old with staphylococcal endocarditis and multiple septic emboli, revealing borderline cardiomegaly, multiple nodular infiltrates, and bilateral pleural effusions.
Lateral chest radiograph of a 15-year-old with staphylococcal endocarditis and multiple septic emboli, revealing borderline cardiomegaly, multiple nodular infiltrates, and bilateral pleural effusions.
CT scan of the thorax (mediastinal windows) of a 15-year-old with staphylococcal endocarditis and multiple septic emboli, revealing bilateral pleural effusions.
CT scan of the thorax (lung windows) of a 15-year-old with staphylococcal endocarditis and multiple septic emboli, demonstrating multiple nodular infiltrates (some with cavitation) consistent with septic emboli, volume loss on the right, and pleural effusions.
CT scan of the thorax (lung windows) of a 15-year-old with staphylococcal endocarditis and multiple septic emboli, revealing multiple nodular infiltrates (some with cavitation) consistent with septic emboli, volume loss on the right, and pleural effusions.
CT scan of the thorax (lung windows) of a 15-year-old with staphylococcal endocarditis and multiple septic emboli, revealing multiple nodular infiltrates (some with cavitation) consistent with septic emboli, volume loss on the right, and pleural effusions.
CT scan of the thorax (lung windows) of a 15-year-old with staphylococcal endocarditis and multiple septic emboli, revealing multiple nodular infiltrates (some with cavitation) consistent with septic emboli, volume loss on the right, and pleural effusions.
Follow-up CT scan of the thorax (lung windows) of a 15-year-old with staphylococcal endocarditis and multiple septic emboli, revealing multiple nodular infiltrates (some with cavitation) consistent with septic emboli, volume loss on the right, and pleural effusions.
Follow-up CT scan of the thorax (lung windows) of a 15-year-old with staphylococcal endocarditis and multiple septic emboli, revealing multiple nodular infiltrates (some with cavitation) consistent with septic emboli and evolution of the lesions over time.
Follow-up CT scan of the thorax (lung windows) of a 15-year-old with staphylococcal endocarditis and multiple septic emboli, revealing multiple nodular infiltrates (some with cavitation) consistent with septic emboli and evolution of the lesions over time.
 
 
 
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