Systemic management of cutaneous bacterial infections.

Cutaneous bacterial infections can be treated by a variety of modalities, although systemic antimicrobial agents usually provide the most efficacious and efficient means for treatment. Oral administration allows outpatient management, thus decreasing the overall cost of treatment. Although gram-negative organisms are increasingly implicated in dermatologic infections, the bacteria that are commonly found in skin infections include group A beta-hemolytic Streptococcus and Staphylococcus aureus, which cause many types of pyoderma or impetigo. Not every patient exhibits the common signs of bacterial skin infection, which can include redness, crusting, induration, increased local temperature, serous exudate, a purulent discharge, pustules, bullae, or a foul-smelling odor, as well as such symptoms as malaise, pain, and tenderness. Bacterial confirmation may also be difficult. Beta-lactam antibiotics, tetracycline, and erythromycin have proven useful in this setting; however, increasing resistance is problematic. The management of bacterial infections of the skin and skin structure has been expanded during the past decade with the introduction of the new fluoroquinolones--agents with a wide spectrum of antimicrobial activity and good pharmacokinetic characteristics. While the clinical efficacy of each agent must be considered in the light of risk of adverse events and potential drug interactions, ciprofloxacin, enoxacin, ofloxacin, and temafloxacin appear to be most useful for cutaneous bacterial infections.