This is a 4-week series focused on bacteria found on our skin, in particular Staphylococcus aureus, a bacterium that can lead to infection and complications in eczema patients. I’m honored to have Dr. Clay Cockerell, the clinical professor of dermatology and pathology and the director of the Division of Dermatopatholgy at University of Texas Southwestern Medical Center in Dallas, Texas, to help in this series.
More on Dr. Cockerell – Dr. Clay Cockerell was the president of the American Academy of Dermatology in 2005. He is a renowned medical educator having overseen an educational program designed to train the next generation of dermatologists and dermatopathologists and the author of numerous papers and textbooks. He is a board-certified dermatologist and dermatopathologist licensed in many states throughout the U.S. His clinical expertise is in skin disorders and his passion has led him to co-found TopMD Skin Care, the company behind CLn® BodyWash.
A common treatment for Staph infection is the use of an antibiotic either topical or oral. Pus may also be drained (only by doctor!). Dr. Clay, what are the common types/names of antibiotics prescribed for Staph infection? And if an antibiotic cream is prescribed, what is the frequency and duration of topical application? Should a parent consult the doctor again if there’s no improvement within the first two days (for possibility of different strain of bacteria involved)? Can a parent apply the same cream the next time a similar-looking rash occurs on the child’s skin?
Dr. Clay: There are a number of antibiotics that are effective against Staph, but unfortunately, many strains of Staph are now resistant to the antibiotics that have been used for years. The most commonly used antibiotics are in the penicillin family, and one of the best is methicillin. Cephalosporins, such as cephalexin, are also good for sensitive strains. Topical antibiotics include bacitracin, Neosporin and mupirocin (Bactroban). These are usually applied two to three times a day. It usually takes several days for improvement to be noted, and there may be redness that lasts for several more days than that. There should be no further spreading of the process, and the pain and redness should start to resolve in two to three days. If there is no improvement, it should be checked by a doctor as it is possible that it is being caused by another rare organism or fungus, or it may be a sign that the patient’s immune response is too weak to help eradicate it with a topical antibiotic alone. In general, if the patient is doing well and develops a similar process, the family can try to treat topically at first. If it does not improve in a few days, the doctor should be notified.
Methicillin-Resistant Staph Aureus (“MRSA”) Infection
A worrying trend is that there is a strain of Staph bacteria, namely the MRSA, which has developed resistance against the commonly prescribed antibiotics noted above. As explained on Dermnet NZ, there is a mec gene in the bacterium that “alters the site at which the methicillin binds to kill the bacteria.” As such, the binding is rendered ineffective, and the MRSA cannot be killed by antibiotics such as methicillin, floxacillin, lactamase-resistant pencillin and amoxicillin.
MarcieMom: What are the antibiotics that can be given to a child that can kill the MRSA? I read that Vancomycin is one such antibiotic, but there are also strains of Staph bacteria that have become resistant to it. What about Bactrim DS (double-strength sulfamethoxazole trimethoprim)?
Dr. Clay: Yes, vancomycin is a commonly used antibiotic that is effective against MRSA, but it cannot be taken orally. If the infection is relatively mild, we generally use Bactrim DS, as it can be taken by mouth and is effective. It is also important to supplement this with measures to try to eradicate it from the skin such as the use of bleach-containing cleansers, like CLn® BodyWash.
MarcieMom: Thank you Dr Cockerell, next week we shall learn about prevention – definitely beats having to treat a staph infection!