Oxacilljn treatment of severe staphylococcal infections.

Observations on 124 patients. The vast majority of the patients had hospital-acquired staphylococcal infections and serious underlying diseases and had been unsuccessfully treated with other antibiotics before the oxacillin therapy was started. The overall mortality in the 124 patients was 35%. In those with well authenticated staphylococcal infections of the lower respiratory tract treated with oxacillin alone the mortality was 44%, whereas in the patients with other infections satisfying the same criteria, the mortality was 28%. These results are more favourable than those obtained in comparable cases treated with diphenicillin and only slight better than in patients treated with methicillin. There were 14 deaths among 25 patients with staphylococcal bacteraemia, a mortality comparable to that observed with methicillin therapy. All strains of staphylococci isolated in this study were uniformly susceptible to oxacillin. Levels of cxacillin in the serum of patients appeared to be comparable with those demonstrated in normal young men, but 2 patients showed no antibacterial activity in the serum after doses given by mouth 2 and 4 hr. after a meal. Superinfection occurred but did not appear to be a major clinical problem. The drug was well tolerated but rashes were noted in 6 patients (4%). Oxacillin is available in forms for both oral and parenteral use. Variability of oral absorption has been demonstrated both in this study of patients and in normal young men. It is therefore recommended that in patients with serious illnesses oxacillin be given parenterally until the critical period has passed.