[Pristinamycin in the treatment of acute bacterial dermohypodermitis in adults. An open study of 42 patients].

INTRODUCTION

We recently demonstrated that oral roxithromycin is as effective as intravenous penicillin G in adults with erysipelas. We therefore evaluated the effectiveness of pristinamycin, an antibiotic which is very active on streptococci and Staphylococcus aureus, in non-necrotizing bacterial dermohypodermitis in adults.

PATIENTS AND METHODS

This prospective open study was conducted in one center and included immunocompetent patients with bacterial dermophypodermitis without signs of toxicity or local manifestations suggesting necrotizing fasciitis. Bacteriology tests included direct immunofluorescence for streptococcus (groups A, C, G) on skin biopsies of the lesion before treatment. Patients were treated with pristinamycin (Pyostacine 500, 3 g/day until 10 days after apyrexia), and evaluated clinically on day 0, 2, 6, 8, and 15. Overall treatment effect was assessed on day 15.

RESULTS

The study group included 42 adults (23 woman and 19 men; mean age 64 +/- 3.5 yr). In 39 cases (93%), the bacterial dermohypodermitis was localized on the lower limb. The inflammatory lesion was well delimited, a characteristic feature of erysipelas, in 32 cases (76%). Sample culture, direct immunofluorescence or serology findings demonstrated presence of streptococci in 33 cases (79%). A single treatment with pristinamycin was successful in 36 patients, giving an overall rate of 86%. Drainage of a localized abscess was successful in 5 of 6 patients after initial failure of antibiotic treatment.

CONCLUSION

This prospective study demonstrated the effectiveness of pristinamycin in non-necrotizing bacterial dermohypodermitis in the adult, especially in erysipelas. Overall effectiveness was comparable with that reported for penicillin G or macrolides in erysipelas.