Emerging problems with antibiotic resistance

How to treat bullous impetigo due to MRSA?

TMP-SMX (oral); Vancomycin (IV, needs hospitalization); Clindamycin (oral, works against most community strains); Linezolid (oral, expensive); Daptomycin

Due to MSSA?

Dicloxacillin (penicillinase-resistant penicillin); cephalexin (1st gen cephalosporin)

Strep pneumoniae

Intermediate- and high-level resistance to penicillins. Treat with ceftriaxone (3rd gen cephalosporin) because resistance is due to changes in penicillin binding protein. You can overcome PBP changes, but not beta lactamase production, with increased dose of drug.

VRE
Created by widespread use of oral vancomycin for C. difficiles infections in the '90s.

UTIs: TMP-SMX, then ciprofloxacin used to be standard treatment. Resistance cropping up.

Otitis media: Empirical amoxicillin. Usually it's Pneumococcus, Moraxella, or H. influenza. Can overcome pneumococcal resistance with higher dose. Moraxella and H. influenza get better anyway -- don't actually need antibiotic. Difficult to culture middle ear and figure out causative bug. If doesn't get better use ampicillin/clavulanic acid combo, or 2nd/3rd gen cephalosporin to overcome beta-lactamase resistance. Ace card is ceftriaxone.

Community-acquired pneumonia: Macrolide or doxycycline; if recent antibiotic treatment, advanced macrolide or quinolone AND amoxicillin/clavulanic acid.