A 39-year-old man with a skin infection
Beth Israel Deaconess Medical Center, Department of Medicine, 110 Francis St, Ste 6A, Boston, MA 02215. .JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 02/2008; 299(1):79-87. DOI: 10.1001/jama.298.21.jrr70002
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.
- Cleveland Clinic Journal of Medicine 06/2008; 75(5):328-9; author reply 329. DOI:10.3949/ccjm.75.5.328-b · 2.71 Impact Factor
- JAMA The Journal of the American Medical Association 06/2008; 299(21):2511; author reply 2511-2. DOI:10.1001/jama.299.21.2511-a · 35.29 Impact Factor
Article: Oritavancin for skin infections[Show abstract] [Hide abstract]
ABSTRACT: Oritavancin (LY-333328) is a semisynthetic lipoglycopeptide for the treatment of serious infections with Gram-positive pathogens, especially methicillin-resistant Staphylococcus aureus and complicated skin and soft tissue infections. A New Drug Application for oritavancin administered intravenously once daily for 3 to 7 days for complicated skin and soft tissue infections was filed with the U.S. Food and Drug Administration in April 2008. This article provides an overview of the publicly available data and includes data presented at the European Congress of Clinical Microbiology and Infectious Disease in April 2008. Although several agents are currently or soon to be available for resistant Gram-positive infections, oritavancin has several key features: (i) multiple mechanisms of antibacterial action; (ii) broad spectrum and high potency against Gram-positive pathogens; (iii) bactericidal activity and long duration of the postantibiotic effect with excellent activity against stationary-phase bacteria and biofilms; (iv) long half-life, allowing infrequent dosing and potentially allowing the entire course of therapy to be a single dose; and (v) documented clinical efficacy and safety.Drugs of today (Barcelona, Spain: 1998) 09/2008; 44(8):563-75. DOI:10.1358/dot.2008.44.8.1250078 · 1.20 Impact Factor
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