Skin and Soft Tissue Infections

Fluoroquinolones yield similar results to standard therapy for both Gram-positive and Gram-negative infections of the skin and soft tissues [72], although emergence of resistance among both staphylococci—notably methicillin-resistant Staphylococcus aureus (MRSA)— and P aeruginosa has been observed [25]. Treatment of diabetic infections, including polymicrobial disease, with the early fluoroquinolones gave results almost as good, but persistence and resistance acquisition proved a greater problem, most frequently in P. aeruginosa infections. Preliminary analyses of the therapy of diabetic foot infections with trovafloxacin and similar agents active against anaerobes, such as the Bacteroides spp., have indicated excellent results. The potential for early IV-oral switch therapy and discharge from hospital is a major advantage in such patients. However, the rapid emergence and spread of quinolone-resistant MRSA among patients—including those previously not exposed to fluoroquinolones—and within hospitals suggest fluoroquinolones to be inappropriate in MRSA infections [16].

Currently available fluoroquinolones have indifferent to modest activity against obligate anaerobes and microaerophilic streptococci, and are usually used in combination in infections where these organisms are involved. However, prior to its suspension, trials of trovafloxacin (MICs for anaerobes of 1 mg/liter or less) gave excellent clinical response rates in intraabdominal and pelvic anaerobic or mixed polymicrobial disease [73]. The potential future roles for other fluoroqui-nolones in surgery and gynecological infections are discussed in Chapter 9.

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