Topical Antibacterial
Introduction
Although many antibacterial drugs are available in topical preparations, some are potentially hazardous and frequently, their use is not necessary if adequate hygienic measures can be taken. Moreover, not all skin conditions that are oozing, crusted or characterized by pustules are actually infected.
Minimize the Development of Resistant Organisms
It is advisable to
- Limit the choice of antibacterials applied topically to those not used systemically.
- Topical mupirocin or fusidic acid should NOT be used for >10 days and local microbiology advice should be sought before using it in hospital.
Topical Options
Aminoglycosides (e.g. neomycin, gentamicin)
- Neomycin sulphate may cause sensitization and there is cross-sensitivity with other aminoglycosides such as gentamicin.
- If large areas of skin are being treated, ototoxicity may also be a hazard with aminoglycoside antibiotics, particularly in children, in the elderly and in those with renal impairment.
Clindamycin
- For acne vulgaris.
Fusidic acid
- A narrow-spectrum antibacterial used for staphylococcal infections.
Metronidazole
- Is used topically for rosacea and to reduce the odour associated with anaerobic infections.
Mupirocin
- Is effective for skin infections (including mild impetigo), particularly those due to Gram-positive organisms, but it is not indicated for pseudomonal infection.
- In the presence of mupirocin-resistant MRSA infection, a topical antiseptic such as povidone-iodine, chlorhexidine or alcohol can be used; their use should be discussed with the local microbiologist.
Silver sulfadiazine
- Is used in the treatment of infected burns.
- Prolonged use of silver sulfadiazine can delay healing of superficial or partial thickness burns; limit use for the prevention of infection to the first 3 days after the burn.
Systemic Treatment
Cellulitis, erysipelas and leg ulcer infections require systemic antibacterial treatment.
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