Penicillins surgical infections

Staphylococcus aureus is responsible for a variety of skin infections which require therapeutic approaches different from those of streptococcal infections. Staphylococcal celluhtis is indistinguishable clinically from streptococcal cellulitis and responds to cloxacillin or flucloxacillin, but generally fails to respond to penicillin owing to penicillinase (/3-lactamase) production. Staphylococcus aureus is an important cause of superficial, localized skin sepsis which varies ftom small pustules to boils and occasionally to a more deeply invasive, suppurative skin abscess known as a carbuncle. Antibiotics are generally not indicated for these conditions. Pustules and boils settle with antiseptic soaps or creams and often discharge spontaneously, whereas carbuncles frequently require surgical drainage. Staphylococcus aureus may also cause... 

Children with SCD should receive prophylactic penicillin until at least the age of 5 years, even if they have been immunized appropriately with PCV 7 against pneumococcal infections. Penicillin V potassium typically is initiated at age 2 months with a dose of 125 mg orally twice daily until age 3 years and then 250 mg orally twice daily until 5 years of age. The intramuscular use of benzathine penicillin 600,000 units every 4 weeks from age 6 months to 6 years is also an option for non-compliant patients. Penicillin-allergic patients may receive erythromycin 10 mg/kg twice daily. Penicillin prophylaxis usually is not continued in children over the age of 6 years but may be considered in patients with a history of invasive pneumococcal infection or surgical splenectomy.6,18-20... 

Cefazolin penetrates well into most tissues. It is a drug of choice for surgical prophylaxis. Cefazolin may be a choice in infections for which it is the least toxic drug (eg, penicillinase-producing E coli or pneumoniae) and in persons with staphylococcal or streptococcal infections who have a history of penicillin allergy other than immediate hypersensitivity. Cefazolin does not penetrate the central nervous system and cannot be used to treat meningitis. Cefazolin is an alternative to an antistaphylococcal penicillin for patients who are allergic to penicillin. 

For infected bite wounds, penicillin and a peniciUinase-resistant penicillin or amoxiciUin-clavulanic acid 875 mg/125 mg oraUy twice daily (40 mg/kg per day oraUy of the amoxicillin component divided into two doses) should be started empirically pending the culture results. Tetracyclines or a combination of clindamycin plus a fluoroquinolone or trimethoprim-sulfamethoxazole may be used as an alternative therapy for the penicillin-allergic patient. Hospitalization for minor wounds is not necessary if surgical repair of vital structures has not been performed. Patients suffering serious injuries or clenched-fist injuries should be started on intravenous antibiotics. Duration of therapy for infected bite injuries should be 7 to 14 days. 

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