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Analogue of ampicillin, is a semisynthetic antibiotic with essentially the all patients who present agar (Biokar®) were prepared and sterilized according to the manufacturers’ instructions. Another drug and may not reflect the rates.

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New Zealand Formulary Patient Information: References. Amoxicillin New Zealand Formulary Antibiotics – choices for common infections BPAC, NZ, 2017. The Maori Pharmacists’ Association have a free phone line to help answer any questions whanau may have about their medicines.

Author: Amy Stanway MBChB, Registrar, Department of Dermatology, Waikato Hospital, Hamilton, New Zealand, 2002. Updated by Dr Jannet Gomez, Postgraduate student in Clinical Dermatology, Queen Mary University London, United Kingdom; Chief Editor: Dr Amanda Oakley, Dermatologist, Hamilton, New Zealand, December 2015. A staphylococcal infection is a common bacterial skin infection.

Staphylococci (‘staph’) are a common type of bacteria that live on the skin and mucous membranes (for example, in the nostrils) of humans. Staphylococcus aureus (S aureus) is


most important of these bacteria in human diseases.

Other staphylococci, including S epidermidis, are considered commensals , or normal inhabitants of the skin surface.


15–40 per cent of healthy humans are carriers of S aureus, that is, they have the bacteria on their skin without any active infection or disease (colonisation).

The carrier sites are usually the nostrils and flexures , where the bacteria may be found intermittently or every time they are looked for.

Despite being harmless in most individuals, S aureus is capable of causing various infections of the skin and other organs.

S aureus infection is common in people with frequent skin injury, particularly if the skin is dry.

Staph skin infections are seen most commonly in pre-pubertal children and certain occupational groups such as healthcare workers. But they may occur for no obvious reason in otherwise healthy individuals. Most staphylococcal infections occur in normal individuals, but


illness and certain skin diseases increase the risk of infection. These include: Severe atopic dermatitis Poorly controlled diabetes Kidney failure, especially those on dialysis Blood disorders such as leukaemia and lymphoma Malnutrition Iron deficiency Alcoholism Intravenous drug users Presence of foreign body, eg prosthetic joint, pacemaker, indwelling catheter , haemodialysis, recent surgical procedure Medication with systemic steroids, retinoids , cytotoxics or immunosuppressives Immunoglobulin M deficiency Chronic granulomatous disease Chediak-Higashi syndrome Job and Wiskott Aldrich syndromes (associations of severe staphylococcal infection with eczema , raised immunoglobulin E and abnormal white cell function) Bacteriology of staphylococcal infection.

S aureus bacteria are classified as Gram-positive cocci based on their appearance under a microscope .

They may occur singly or grouped in pairs, short chains or grape-like clusters.

They are usually facultative anaerobes ,


is, they are capable of surviving at various levels of


, and are generally very hardy organisms . They are only able to invade via broken skin or mucous membranes , hence intact skin is an excellent human defence.

Once they have invaded they have various ways to avoid host defences. They: Hide their antigens to avoid an immune response Kill infection-fighting cells ( phagocytes ) Survive within host infection-fighting cells.

Develop resistance to antibiotics Release toxins (intoxication) – these do not require the presence of live bacteria to have an effect. Staphylococcal skin infection can present in a variety of ways: Hair follicle infections including staphylococcal folliculitis, boils (furuncles and carbuncles), abscess and sycosis (beard infection) Impetigo (school sores) Ecthyma ( crusted ulcers ) Cellulitis (more often due to streptococcus) Secondary skin infection of wounds, dermatitis, scabies, diabetic ulcers etc.

Mastitis ( inflammation of the breast) and abscess of the breast; the bacteria may pass from a breast abscess into milk Staphylococcal hypersensitivity reactions such as folliculitis decalvans (a


of scarring hair loss) Staphylococcal infection. Skin disease due to toxins produced by the bacteria include: Staphylococcal scalded skin syndrome (SSSS), which usually affects children less than five years old or rarely, adults with kidney failure. This is a relatively uncommon illness usually resulting from the release of Toxic Shock Syndrome Toxin -1 (TSST-1) or enterotoxin B. These toxins are also known as superantigens as they are capable of generating a massive inflammatory response.

Previous exposure makes a patient immune to these toxins, ie they will not have a second attack.

Staphylococcal toxins can also cause food poisoning. The diagnosis of staphylococcal skin infection is often clinical. If there are difficulties in diagnosis, or first-line treatment fails, the diagnosis can be confirmed by a positive laboratory culture of a swab from the infected site or blood culture.

In staphylococcal intoxication, there may be no viable bacteria to culture and the diagnosis may be made retrospectively on the basis of a blood test demonstrating an immune response (seroconversion) to toxins following a compatible illness.

The treatment of staphylococcal infection includes: Appropriate antibiotics, including oral antibiotics cephalexin, clindamycin, amoxicillin/clavulanate Drainage of pus from infection site Surgical removal ( debridement ) of dead tissue ( necrosis ) Removal of foreign bodies (eg stitches) that may be a focus of persisting infection Treating the underlying skin disease (eg atopic eczema) Antibiotic resistance.



becoming increasingly resistant to many commonly used antibiotics including penicillins, macrolides such as erythromycin, tetracyclines and aminoglycosides . Penicillin resistance in S aureus is due to production of an enzyme called beta-lactamase or penicillinase.

Methicillin (meticillin) and flucloxacillin are lactamase-resistant penicillins so are the antibiotics of choice in most staphylococcal skin infections. Unfortunately, there is now increasing methicillin resistance (MRSA). Penicillins with a beta-lactamase- inhibitor such as amoxicillin + clavulonic acid may be used to treat Staph. aureus infections and are sometimes effective against bacteria resistant to flucloxacillin.



have a broad range of action against several bacteria and are best reserved for patients with mixed bacterial infections.

Patients who are allergic to penicillin are most reliably treated with vancomycin, although for minor infections macrolides such as erythromycin may be adequate.

Macrolide resistance is also high among S aureus but macrolides may be taken by mouth whereas vancomycin requires intravenous administration. Due to widespread antibiotic resistance, it is better to prevent staphylococcal infection


possible. The most effective way is to wash hands often, and before and after touching broken skin. It is also important to clear bacteria colonising the nostrils and under the fingernails with either antibiotic ointment (eg.

fusidic acid or mupirocin) or petroleum jelly several times daily for one week of each month.

5 things you need to know about antibiotics this flu season.

When Joseph developed a persistent cough, he booked a visit with his longtime family physician.



diagnosed bronchitis and recommended rest and plenty of fluids. “The flu is going around my office, and I have deadlines to meet.” The doctor hesitated. Then he saw how anxious Joseph was and agreed to call in a prescription.

Joseph and his doctor are unknowingly contributing to the rise of “superbugs,” or drug-resistant germs.

Treating a cough with an occasional Tylenol or Advil won’t do any harm, even if the medication doesn’t


your symptoms. But antibiotics are different, as overuse and misuse can harm you ? and the people you love ? in the long term. Read on to learn which flu treatments are most effective, how to avoid unnecessary antibiotics, and ways you can help fight the rise of dangerous superbugs. The drugs won’t relieve your symptoms, reduce the length of your illness or boost your immunity to other germs.

Sure, you may feel better after taking antibiotics, for a simple reason: You were already on the road to recovery.

We all tend to seek treatment when our symptoms are at their peak. Over the


few days, as the virus runs


course, you start to feel better.

But that would have happened even without medication.

Sometimes, antibiotics can actually make you feel worse. “Antibiotics are generally quite safe, but they do carry some risk,” says Daniel Knecht, MD, MBA, VP of clinical strategy and policy for Aetna. “They may cause diarrhea, allergic reactions and various other side effects.” It’s something to keep in


if you’re tempted to take unnecessary antibiotics “just in case.” How to treat flu symptoms. The best medicine for the flu depends on the timing. Besides the usual over-the-counter cold-and-flu formulas, doctors recommends the following: The flu shot. You probably know that the


vaccine helps you avoid developing the flu. But the vaccine also reduces the strength of the virus if you do catch it.

(You might even mistake it for a mild cold.) The catch: You have to get your shot before you come down with the flu ? ideally at least a few weeks prior, so your body has time to build up defenses against the virus.

Staying extra hydrated can make you feel more comfortable and speed your recovery. Treat yourself to a favorite beverage that will encourage you to keep drinking: juice, electrolyte water, chicken soup or herbal tea with honey and lemon.

For stomach upset, some people swear by ginger root; natural ginger ale or ginger tea are two good sources.

To relieve cough and nasal congestion, the fumes of a menthol ointment, like Vicks VapoRub, or eucalyptus oil (sniff from the bottle or add a few drops to hot water) can help you breathe easier.

Inhaling steam is another way to soothe airways; use a humidifier or sit in the bathroom while you run a very hot shower.

And you can break up mucus in your nose and throat by gargling with salt water or using a neti pot.

Recommended only for high-risk individuals, like seniors and people with chronic medical conditions.

Ask a doctor or pharmacist about prescription flu treatment.

Tamiflu is an antiviral drug taken by mouth that prevents the virus from multiplying in your body. It decreases your symptoms and the length of time you’re sick. You must take Tamiflu at the first sign of symptoms.

Antibiotic resistance refers to the ability of some germs to survive the drugs we take to kill them. When you need antibiotics ? and when to avoid them. Viruses and bacteria are two types of germs that can cause infection and disease. Antibiotics kill bacteria, but have no effect on viruses. Some illnesses always require antibiotic treatment: strep throat, staph-based skin infections and common sexually transmitted diseases like chlamydia. Other conditions may be caused by either bacteria or viruses, and it can be hard to tell the difference.

If you develop pneumonia, pink-eye or a urinary tract infection, for instance, your doctor may test for bacteria before recommending antibiotics.

Always Sometimes Never Strep throat UTI Cold Tuberculosis Pink-eye Flu Chlamydia Sinus infection Bronchitis E.

coli Pneumonia Yeast infection Staph infection Ear-ache Herpes.

Most illnesses that send people to their doctor are caused by viruses or allergies.

Typically, you just have to let a virus run its course. Yet 30% to 50% of antibiotics are prescribed for viral illnesses, like bronchitis. “It’s very validating and comforting for patients to receive an antibiotic prescription when they’re not feeling well,” Dr.

“And doctors want to help.” But such overuse is a major contributor to antibiotic resistance. Antibiotic resistance refers to the ability of some germs to survive the drugs we take to kill them. This can happen as a result of overuse, described above, or misuse, as when a patient with strep throat misses doses of their antibiotics or stops taking their pills once they feel better. Instead of being killed, the strep bacteria are, in the words of one scientist, “


” in how to fight the drug. Then, if those germs are passed to someone else, the same antibiotic will be less effective.

“Superbugs” are germs that are resistant to many antibiotics. The best-known superbug is MRSA (pronounced MER-suh ), a drug-resistant form of staph.

Other superbugs cause hard-to-treat forms of pneumonia, tuberculosis, gonorrhea and UTIs.

Every year, 2 million Americans fall ill with antibiotic-resistant infections. Today, a simple sore throat or UTI might inconvenience you for a week,


your inexpensive generic antibiotics kick in. In the future, that week could turn into a month ? and multiple rounds of pricey specialized antibiotics.

“Antibiotics are the unsung hero that support many medical breakthroughs,” Dr. “There’s a whole slew of technologies we wouldn’t be able to use if antibiotics stopped working: surgery, dialysis, chemotherapy, gene therapy, bone marrow transplants.” All of these treatments would be too dangerous without effective ways to head off and treat infection. The good news is that we’re making progress in the battle against superbugs. Aetna is working to educate doctors about the dangers of overprescribing antibiotics for common complaints like acute bronchitis, in collaboration with the Centers for Disease Control and Prevention (CDC) and state Departments of Health. In 2018, the program reduced unnecessary prescriptions by 16%. In 2019, the initiative will be expanding to additional states. You can fight the rise of antibiotic-resistant superbugs by asking the right questions and taking your medication as directed. If your doctor offers to prescribe you antibiotics, ask if they’re really necessary.

“Doctors may think people are coming to them for antibiotics,” Dr.

“Asking doctors if antibiotics are needed lets them know that you’re there for the right treatment, whatever that is.” And if you do need antibiotics for a bacterial illness, don’t skip doses and do take all the pills prescribed to you, even after you feel better.

“Imagine a world where you don’t know if antibiotics will work,” Dr. “Many people don’t recognize how important they are.

We need to elevate their status and preserve this precious resource.” Use of Antibiotics for Treating UTIs in Dogs and Cats.

Understanding drug pharmacokinetics and pharmacodynamics is essential when determining the most effective antibiotic therapy for UTIs in dogs and cats. Foster is an internist and Director of the Extracorporeal Therapies Service at Friendship Hospital for Animals in Washington, D.C. He has lectured around the world on various renal and urinary diseases and authored numerous manuscripts and book chapters on these topics. He is the current president of the American Society of Veterinary Nephrology and Urology. Urinary tract infections (UTIs) are common in small animal practice; it has been reported that up to 27% of dogs will develop infection at some time in their lives. Most UTIs are successfully treated with commonly used drugs, dosages, and administration intervals.

However, infections can be challenging to effectively treat when they involve the kidneys (pyelonephritis) and prostate (prostatitis).

In addition, it can be difficult to create an appropriate antibiotic prescription in patients


kidney disease due to reduced drug clearance. Understanding drug pharmacokinetics (PK) and pharmacodynamics (PD) is essential when determining the most effective antibiotic therapy. In addition, successful antimicrobial therapy requires appropriate choice of antibiotic, including dose, frequency, and duration ( Figure 1 ).

Nearly all infections are caused by pathogenic bacteria, although fungal or viral UTIs may be rarely encountered. Most bacterial lower UTIs result from bacteria ascending the external genitalia and urethra. Less commonly, bacteria travel hematogenously and colonize the urinary tract.

Numerous innate defense mechanisms help prevent a UTI.

Complete and regular voiding, along with intrinsic properties of urine (high osmolality, antimicrobial solutes), helps create a hostile environment for microbes within the urinary tract.

Anatomic barriers and mucosal defenses further prevent adherence of virulent bacteria to the urothelium. Pathogenic bacteria increase the permeability of the urothelium, allowing passage of inflammatory solutes into the subepithelium as well as inflammatory cytokine secretion. 2 The result is inflammation and pain, which manifest as dysuria, pollakiuria, stranguria, and/or hematuria. Eradication of the virulent organism can allow


normal permeability and integrity of the


to be restored.

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