Cephalexin, given twice daily, and
dicloxacillin, given four times daily, were compared in a randomly controlled study for the treatment of staphylococcal skin and skin structure
infections. Among 70 evaluable patients, 57 had staphylococcal bullous
impetigo. The remaining 13 patients had bullous
impetigo with streptococcal or mixed streptococcal-staphylococcal cultures (6 patients),
abscess (4 patients), or
cellulitis with
pyoderma (3 patients). Staphylococci were recovered from lesions of 64 of the 70 evaluable patients; all strains were sensitive to both
cephalexin and
dicloxacillin, but only 2 of the 64 strains were susceptible to
penicillin G.
Cephalexin and
dicloxacillin proved equally effective. Treatment failures were uncommon (1 patient in each group), and recurrences (3 patients in each group) were limited to patients with bullous
impetigo. In general, patients with staphylococcal bullous
impetigo responded promptly, with clearing of lesions evident within the first week, but delayed healing with persistence of staphylococci in lesions was more common in the group receiving
dicloxacillin. Twice-daily dosing with oral
antibiotics is obviously convenient and may enhance compliance. Twice-daily
therapy with
cephalexin for staphylococcal skin and skin structure
infections can be recommended with confidence.