Soft-tissue infections antibiotics

These antibiotics are effective in die treatment of infections caused by a wide range of gram-negative and gram-positive microorganisms. The tetracyclines are used in infections caused by Rickettsiae (Rocky Mountain spotted fever, typhus fever, and tick fevers). Tetracyclines are also used in situations in which penicillin is contraindicated, in the treatment of intestinal amebiasis, and in some skin and soft tissue infections. Oral... 

However, local anesthetics may be helpful when abrasion accompanies the injury.39 Application of an over-the-counter antibiotic ointment containing an anesthetic may provide soothing relief, promote healing of abrasions, and prevent soft-tissue infection. Minor abrasions should be cleansed thoroughly with mild soap and water before application. More severe abrasions may require removal of debris or foreign bodies by a clinician followed by irrigation with normal saline. 

Every patient receiving antimicrobial therapy for skin and soft tissue infections must be monitored for efficacy and safety. Efficacy typically is manifested by reductions in temperature, white blood cell count, erythema, edema, and pain that begin within 48 to 72 hours. To ensure safety, dose antibiotics according to renal and hepatic function as appropriate, and monitor for and minimize adverse drug reactions, allergic reactions, and drug interactions. 

When considering antimicrobial therapy in a patient with fever, one should answer the following questions. First, is the fever caused by an infection If affirmative, data are needed to determine the severity of the infection, the site of infection, and the causal micro-organism(s). Second, when the cause of the fever is infectious, one should ask is treatment with antimicrobial drugs needed Many soft tissue infections including impetigo and decubital ulcers are best treated with local antiseptics and/or wound debridement without the use of antibiotics. If the chance to cure the infection with antimicrobial... 

Local treatment of skin and soft tissue infections with antibiotic-containing ointments or solutions should not be used because it leads to allergic reactions and rapid development of bacterial resistance. In settings where MRSA or resistant Enterobacte-riaceae (like ESBL s gram negative bacteria with extended spectrum beta lactames) or Pseudomonas spp. occur, the empiric use of vancomycin and a carbapenem can be necessary. The risk of transmission of these organisms should be minimalised by hygienic and isolation measures. 

In necrotising soft tissue infections surgical debridement is the mainstay of therapy. There is not much evidence in support of topical application of antibiotics in irrigation fiuids topical antibiotics are reported to cause allergic contact dermatitis in up to 5-20%. Irrigations with acetic acid can reduce colonisation of wounds with Pseudomonas sp. 

Meropenem (Merrem) is another carbapenem antibiotic with a broad spectrum of activity comparable to that of imipenem. A methyl group attached at the one-position on the five-member ring confers stability to dehydropeptidase 1. Consequently, meropenem does not require administration with cilastatin. When compared in human trials, imipenem-cilastatin and meropenem achieve similar clinical outcomes in patients with serious intraabdominal and soft tissue infections. Both imipenem-cilastatin and meropenem are used to treat infections caused by highly resistant Klebsiella pneumoniae producing ESBLs.The major cUnicaUy relevant distinction between imipenem-cilastatin and meropenem... 

Linezolid s a novel oxazolidinone antibiotic with exclusively Gram-positive activity (including MRSA) which acts at the level of the 30S and 70S ribosomal subunits by a unique mechanism it inhibits protein synthesis by preventing formation of initiation complexes. Linezolid has excellent oral bioavailability and tissue penetration the most important adverse effect is marrow suppression which is usually reversible. Its major indications are soft tissue infections and nosocomial pneumonia, although these will probably expand in the future. 

Ten patients with peripheral arterial occlusive disease were scheduled to undergo elective percutaneous transluminal angioplasty after a single dose of ciprofloxacin 400 mg (66). Antibiotic concentrations were significantly reduced in ischemic lesions compared with healthy adipose tissue. However, improvement of arterial blood flow in the affected limb was associated with increased cure rates of soft tissue infections. 

Indications Respiratory tract, urinary and soft tissue infections Category Antibiotic, macrolide Half-life 8-15 hours... 

The proper route of administration for an antimicrobial depends on the site of infection. Parenteral therapy is warranted when patients are being treated for febrile neutropenia or deep-seated infections such as meningitis, endocarditis, and osteomyelitis. Severe pneumonia often is treated initially with intravenous antibiotics and switched to oral therapy as clinical improvement is evident. Patients treated in the ambulatory setting for upper respiratory tract infections (e.g., pharyngitis, bronchitis, sinusitis, and otitis media), lower respiratory tract infections, skin and soft tissue infections, uncomplicated urinary tract infections, and selected sexually transmitted diseases may receive oral therapy. 

Cefadroxil, a first-generation cephalosporin antibiotic (500 to 2 g p.o. daily), is indicated in urinary tract, skin, and soft-tissue infections caused by susceptible organisms. 

This antibiotic is equal to erythromycin against Campylobacter spp. Its clinical use is limited to treatment of pharyngotonsillitis, mild-to-moderate respiratory tract infections, and skin and soft tissue infections [115]. The major advantage of dirithromycin over erythromycin is the favorable pharmacokinetic properties permitting once-daily oral administration of 500 mg. 

Therapeutic usage of this antibiotic is found in Europe, South America and Japan, where extensive clinical studies have been done. Its pharmacokinetic profile is characterized by high plasma, tissue, and body fluid concentrations and a long half-life of 15 hr [137]. The drug is well tolerated orally at either a dose of 150 mg twice daily or 300 mg once daily, with peak and trough serum concentrations of 7 or 11 pg and 2.5 or 3 pg, respectively [138, 139]. Roxithromycin has proven clinical efficacy in oral and dental infections, upper and lower respiratory tract infections, skin and soft tissue infections, and urogenital infections. 

For skin and soft tissue infections, roxithromycin is an effective and well-tolerated therapy for erysipelas and acne [162, 163]. As with other macrolide antibiotics, its immunomodulatory effects make it useful as an adjunctive therapy of psoriasis vulgaris [164]. Despite its in vitro activity against Borrelia burgdorferi, monotherapy with this macrolide was not effective for the treatment of Lyme borrelio-sis [165]. However, a small, nonrandomized, open prospective clinical study of 17 patients with confirmed late Lyme disease (stage n/III) showed a 76% complete recovery rate from a therapeutic combination of roxithromycin 300 mg... 

Deeper bacterial infections of the skin include folliculitis, erysipelas, cellulitis, and necrotizing fasciitis. Since streptococcal and staphylococcal species also are the most common causes of deep cutaneous infections, penicilUns (especially ji-lactarruise-resistant ji-lactams), and cephalosporins are the systemic antibiotics used most frequently in their treatment (see Chapter 44). A growing concern is the increased incidence of skin and soft tissue infections with hospital- and community-acquired methicillin-resistant S. aureus (MRSA) and drug-resistant pneumococci. Infection with community-acquired MRSA often is susceptible to trimethoprim—sulfamethoxazole. 

Prescribers give patients macrolide antibiotics to fight soft tissue infections, skin infections, and infections of the respiratory and gastrointestinal tract. 

Lincomycin (Lincocin) has been used in the past to treat serious streptococci, pneumococci, and staphylococci infections but has generally been replaced by safer and more effective antibiotics. Clindamycin (Cleocin) is a semisynthetic derivative of lincomycin and has a similar mechanism but is more effective. It is indicated for the treatment of bone and joint infections, pelvic (female) and intraabdominal infections, bacterial septicemia, pneumonia, and skin and soft tissue infections. In a normal dose, lincosamides prevent the growth of bacteria (bacteriostatic). In larger doses, it kills bacteria (bacteriocidal). 

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