Rheumaderm pp 397-406 | Cite as

Newer Concepts in Antimicrobial Therapy

  • Lawrence Charles Parish
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 455)


Antimicrobial agents continue to play a significant role in clinical practice not only due to their active role in the treatment of bacterially induced infections. The accompanying anti-inflammatory characteristics and their antagonism against superantigens add to their importance. The practitioner must also be aware of both overt and covert unwanted effects.

During the past decade, the new quinolones, advanced macrolides, and better cephalosporins have been introduced. The staid penicillins have been up-graded with the addition of a α-lactamase inhibitor.

Many antibiotics have been available for several decades but new uses for them and their derivatives permit the dermatologist to have a more versatile armamentarium. Rifamycin has been shown to be effective in the treatment of leishmaniasis. The new macrolide, clarithromycin, will reduce the lesions of acne vulgaris and acne rosacea.

Although phototoxicity was well recognised in the sulfonomides, several quinolones can create similar light-induced problems. Bullous diseases are known to be instigated by the penicillins, while vasculitis may be caused by a quinolone. Even porphyria has been reported to be induced by a tetracycline.

Antimicrobial therapy has been an integral part of dermatologic practice since the introduction of the sulfa drugs six decades ago. Whether skin is affronted by more pathogenic bacteria than any other organ or whether the percentage of infectious etiologies is greater for cutaneous maladies than for other organ afflictions is not germane to this pres- entation. The facts remain that signs and symptoms of many dermatitides are diminished or even eliminated by antimicrobials [1, 2, 3, 4].


Antimicrobial Therapy Antimicrob Agent Clavulanic Acid Skin Structure Cefuroxime Axetil 
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  1. 1.
    Parish L C, Witkowski J A, Vassileva S: Color Atlas of Cutaneous Infections. Boston: Blackwell Scientific, 1995.Google Scholar
  2. 2.
    Parish L C, Jungkind D L: Systemic antimicrobial therapy in skin and skin structure infections: Comparison of temafloxacin and ciprofloxacin. Am J Med; 91:115S-119S. 1991Google Scholar
  3. 3.
    Harahap M: Diagnosis and Treatment of Skin Infections. Oxford: Blackwell Science; 463. 1997Google Scholar
  4. 4.
    Findlay G H: The Dermatology of Bacterial Infections. Oxford: Blackwell Scientific; 370. 1987Google Scholar
  5. 5.
    Craft J C: Antimicrobial therapy. In: Parish L C, Milikan L E, ed. Global Dermatology. New York: Springer-Verlag; 309–316. 1994Google Scholar
  6. 6.
    Parish L C, Witkowski J A: Cutaneous bacterial skin infections: How to manage primary, secondary, and tertiary lesions. Postgrad Med; 91: 119–122, 125-126, 129-130. 1992PubMedGoogle Scholar
  7. 7.
    Epstein M E, Amodio-Groton M, Sadick N S: Antimicrobial agents for the dermatologist. II. Macrolides, fluoroquinolones, rifamycins, tetracyclines, trimethoprim-sulfamethoxazole, and clindamycin. J Am Acad Dermatol; 37:365–81; quiz 382-4. 1997PubMedCrossRefGoogle Scholar
  8. 8.
    Epstein M E, Amodio-Groton M, Sadick N S: Antimicrobial agents for the dermatologist. I. Beta-lactam antibiotics and related compounds. J Am Acad Dermatol; 37:149–65; quiz 166-6. 1997PubMedCrossRefGoogle Scholar
  9. 9.
    Darmstadt G L: Oral antibiotic therapy for uncomplicated bacterial skin infections in children. Pediatr Infect Dis J; 16:227–40. 1997PubMedCrossRefGoogle Scholar
  10. 10.
    Chapel K L, Rasmussen J E: Pediatric dermatology: advances in therapy. J Am Acad Dermatol; 36:513–26; quiz 527-30. 1997PubMedCrossRefGoogle Scholar
  11. 11.
    Keller H: Adverse reactions to penicillins, tetracyclines, sulfonamides and quinolones. Infection; 19(Suppl 1):s19–s24. 1991PubMedGoogle Scholar
  12. 12.
    Gentry L D: Therapy with newer oral beta-lactam and quinolone agents for infections of the skin and skin structures: A review. Clin Infect Dis; 14:285–297. 1992.PubMedCrossRefGoogle Scholar
  13. 13.
    Parish L C, Aten E M: Treatment of skin and skin structure infection: A comparative study of Augmentin and Cefaclor. Cutis; 34:567–570. 1984PubMedGoogle Scholar
  14. 14.
    Goldstein E J C: Outpatient therapy of bite wounds: Demographic data, bacteriology and a prospective randomised trial of amoxicillin/clavulanic acid versus penicillin ± dicloxacillin. Int J Dermatol; 26:123–127. 1987PubMedCrossRefGoogle Scholar
  15. 15.
    Goldstein E J, Citron D M: Comparative activities of cefuroxime, amoxicillin-clavulanic acid, ciprofloxacin, enoxacin and ofloxacin against aerobic and anaerobic bacteria isolated from bite wounds. Antimicrob Agents Chemother; 32:1143–1148. 1988PubMedCrossRefGoogle Scholar
  16. 16.
    Gomez A, Saul A, Bonifaz A et al: Amoxicillin and clavulanic acid in the treatment of actinomycetoma. Int J Dermatol; 32:218–220. 1993PubMedCrossRefGoogle Scholar
  17. 17.
    Powers R D: Open trial of oral fleroxacin versus amoxicillin.clavulanate in the treatment of infections of skin and soft tissue. Am J Med; 94(suppl 3A): 155S–158S. 1993PubMedGoogle Scholar
  18. 18.
    Smith J W, Nichols R L: Comparison of oral fleroxacin with oral amoxicillin/clavulanate for treatment of skin and soft tissue infections. Am J Med; 94(Suppl 3A):150S–154S. 1993PubMedGoogle Scholar
  19. 19.
    Todd P A, Benfield P: Amoxicillin/clavulanic acid: An update of its antibacterial activity, pharmacokinetic properties and therapeutic use. Drugs 39:264–307. 1990PubMedCrossRefGoogle Scholar
  20. 20.
    Moellering R C, Sentochnik D E: Cephalosporins In: Gorbach S L, Bartlett J G, Blacklow N R:, ed. Infectious Diseases. Philadelphia: W B Saunders, 179–180. 1992Google Scholar
  21. 21.
    Parish L C, Witkowski J A, Snow R et al: Cephalosporins in cutaneous infections: A prospective comparison of two dosage regimens of certazidine for therapy of skin and skin structure infections. Int J Dermatol 25:258–265. 1986PubMedCrossRefGoogle Scholar
  22. 22.
    Parish L C, Witkowski J A: Cephalosporin therapy in dermatologic practice. Clin Dermatol 9:459–470. 1991PubMedCrossRefGoogle Scholar
  23. 23.
    Stevens D L, Pien F, Drehobl M: Comparison of oral cefpodoxime proxetil and cefaclor in the treatment of skin and soft tissue infections. Diagn Microbial Infect Dis 16:123–129. 1993CrossRefGoogle Scholar
  24. 24.
    Nolen T M: Clinical trials of cefprozil for treatment of skin and skin structure infections: A review. Clin Infect Dis 14(Suppl 2):S255–263. 1992PubMedCrossRefGoogle Scholar
  25. 25.
    Parish L C, Doyle C A, Durham S J et al: Cefprozil versus cefaclor in the treatment of mild to moderate skin and skin-structure infections. Clin Ther 14:458–469. 1992PubMedGoogle Scholar
  26. 26.
    Solomon E, McCarty J M, Morman M R et al: Comparison of cefprozil and amioxicillin/clavulanate potassium in the treatment of skin and skin structure infections in adults. Adv Therapy 9:157–165. 1992Google Scholar
  27. 27.
    Wachs G, Rogan M P: Cefprozil vs. Erythromycin for mild to moderate skin and skin structure infections. Infect Med 9 (Suppl E):57–65. 1992Google Scholar
  28. 28.
    Wiseman L R, Benfield P: Cefprozil. A review of its antibacterial activity, pharmacokinetic properties and therapeutic potential. Drugs 45:295–317. 1993PubMedCrossRefGoogle Scholar
  29. 29.
    Hardy D J, Guay D R, Jones R N: Clarithromycin, a unique macrolide: A pharmacokinetic, microbiological and clinic overview. Diagn Microbiol Infect Dis 15:39–53. 1992PubMedCrossRefGoogle Scholar
  30. 30.
    Parish L C et al: Clarithromycin in the treatment of skin and skin structure infections: Two multicenter clinical studies. Int J Dermatol 32:528–532. 1993PubMedCrossRefGoogle Scholar
  31. 31.
    Sturgill M G, Rapp R P: Clarithromycin: Review of a new macrolide antibiotic with improved microbiologic spectrum and favorable pharmacokinetic and adverse effect profiles. Ann Pharmacother 26:1099–1108. 1992PubMedGoogle Scholar
  32. 32.
    Daniel R et al: Azithromycin, erythromycin and cloxacillin in the treatment of infections of skin and associated soft tissues. J Int Med Res 19:433–445. 1991PubMedGoogle Scholar
  33. 33.
    Drew R H, Gallis H A: Azithromycin — Spectrum of activity, pharmacokinetics and clinical applications. Pharmacotherapy 12:161–173. 1992PubMedGoogle Scholar
  34. 34.
    Kiani R: Double-blind, double-dummy comparison of azithromycin and cephalexin in the treatment of skin and skin structure infections. 10:880–884. 1991Google Scholar
  35. 35.
    Mallory S B: Azithromycin compared with cephalexin in the treatment of skin and skin structure infection. Am J Med 91 (Suppl 3A):36S–39S. 1991PubMedCrossRefGoogle Scholar
  36. 36.
    Peters D H, Fiedel H A, McTavish D: Azithromycin. A review of its antimicrobial activity, pharmacokinetic properties and clinical efficacy. Drugs 44:750–799. 1992PubMedCrossRefGoogle Scholar
  37. 37.
    Whitman M S, Tunkel A R: Azithromycin and clarithromycin: Overview and comparison with erythromycin. Infect Control Hosp Epidemiol 13:357–368. 1992PubMedCrossRefGoogle Scholar
  38. 38.
    Derriennic M, Escande J P: Drithromycin in the treatment of skin and skin structure infections. J Antimicrob Chemothr 31 (Suppl C): 159–168. 1993CrossRefGoogle Scholar
  39. 39.
    Bryskier A: Fluoroquinolones: Mechanisms of action and resistance. Int J Antimicrob Ag 2:151–184. 1993CrossRefGoogle Scholar
  40. 40.
    Gentry L D: Review of quinolones in the treatment of infections of the skin and skin structure. J Antimicrob Chemother 28(Suppl C): 97–100. 1991PubMedCrossRefGoogle Scholar
  41. 41.
    Hooper D C, Wolfson J S: Fluoroquinolone antimicrobial agents. N Engl J Med 324:384–394. 1991PubMedCrossRefGoogle Scholar
  42. 42.
    Parish L C, Witkowski J A: The quinolones and dermatologic practice. Int J Dermatol 25:351–356. 1986PubMedCrossRefGoogle Scholar
  43. 43.
    Parish L C, Witkowski J A: Quinolones and cutaneous disease. In: Siporin C, Heifetz C L, Domagala J M: ed. The New Generation of Quinolones. New York: Marcel Dekker, 243–248. 1990Google Scholar
  44. 44.
    Parish L C, Asper R: Systemic treatment of cutaneous infections: A comparative study of ciprofloxacin and cefotaxime. Am J Med 82 (Suppl 4A):227–229. 1987PubMedGoogle Scholar
  45. 45.
    Parish L C, Witkowski J A, Jungkind D L et al: Treatment of cutaneous infections: Worldwide experience with ciprofloxacin. Int J Dermatol 27:131–133. 1988PubMedCrossRefGoogle Scholar
  46. 46.
    Shah P M: Ciprofloxacin. Int J Antimicrob Agents 1:75–96. 1991PubMedCrossRefGoogle Scholar
  47. 47.
    Mirensky Y M, Parish L C: Photosensitivity and the quinolones. J Eur Acad Dermatol Venereol 4:1–4. 1995CrossRefGoogle Scholar
  48. 48.
    Drew R H, Gallis H A: Ofloxacin: Its pharmacology, pharmacokinetics and potential for clinical application. Pharmacotherapy 8:35–46. 1988PubMedGoogle Scholar
  49. 49.
    Gentry L D, Rodriquez-Gomez G: Ofloxacin treatment of difficult infections of the skin and skin structure. Cutis 51:55–58. 1993PubMedGoogle Scholar
  50. 50.
    Lipsky B A, Yarbrough D R, 3rd, Walker F B, 4th, et al: Ofloxacin versus cephalexin for treating skin and soft tissue infections. Int J Dermatol 31:443–445. 1992PubMedCrossRefGoogle Scholar
  51. 51.
    Mouton Y, Leroy O: Ofloxacin. Int J Antimicrob Agents 1:57–74. 1991PubMedCrossRefGoogle Scholar
  52. 52.
    Sanders W E, Jr.: Oral ofloxacin: A critical review of the new drug application. Clin Infect Dis 14:539–554. 1992PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1999

Authors and Affiliations

  • Lawrence Charles Parish
    • 1
  1. 1.Departments of Dermatology and Cutaneous BiologyJefferson Medical College of Thomas Jefferson UniversityPennsylvaniaUSA

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