皮肤金黄色葡萄球菌感染的抗菌药物选择

The Appropriate Antimicrobial Drug in Staphylococcal Aureus Skin Infection

常见由金黄色葡萄球菌引起的感染性皮肤病有脓疱疮、毛囊炎、疖、痈和葡萄球菌烫伤样皮肤综合征等。目前临床上系统治疗建议首选耐青霉素酶半合成青霉素和头孢类抗生素,慎重选择红霉素。耐甲氧西林金葡菌感染时推荐使用夫西地酸或万古霉素等糖肽类抗生素,备选用药为利奈唑胺。浅表、局限金葡菌感染时可外用药物莫匹罗星,其他如夫西地酸、喹诺酮类抗生素和复方多黏菌素B等也是可供选择的外用药。鉴于金葡菌对多种抗生素的耐药性增加,应进行流行病学监测,根据耐药结果调整经验治疗。

The most common skin infectious diseases caused by staphylococcus aureus range from impetigo or furunculosis to the severe forms such as carbuncle and staphylococcal scalded skin syndrome. The best choice for its systemic therapy is 13-1actamase-resistant penicillin or cephalosporin. Fusidic acid, vancomycin or linezolid are recommended when methicillin-resistant staphylococcus aureus is isolated. Superficial and limited infection can be cured by topical using mupirocin. Some other topical antibiotics such as fusidic acid, ciprofloxacin ointment and compound polymyxin B ointment are considerable alternatives. Clinical diagnosis as well as the data from epidemiologic surveillance of the spread of antibiotic resistance provides important reference for adjusting the treatment.