Treatment of Suspected Staphylococcal Infection

To the Editor:—  A recent letter about the dangerous triangle warrants further comment (209:561, 1969). Dr. Eckberg gives a concise and complete description of the progression of superficial facial infections to cavernous sinus thrombosis. However, several aspects of the treatment must be questioned. Despite antibiotic disk sensitivities, tetracycline is not an appropriate antibiotic for staphylococcal infections. Whenever a life-threatening staphylococcal infection is suspected (eg, cavernous sinus thrombosis) the patient should be treated with antibiotics effective against penicillinase-producing staphylococci. Methicillin and the cephalosporin derivatives and vancomycin are examples of such drugs. They may be used alone or in conjunction with penicillin, which is the most effective agent for nonpenicillinase-producing staphylococci. These drugs are not only bactericidal ( tetracycline is bacteriostatic), but also circumvent the problem of rapidly emerging drug resistance which contraindicates tetracycline in staphylococcal infections. Equally important, cortisone and irradiation provide no benefit in staphylococcal infections (183:462, 1963) and