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.
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.
Summary
To 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.
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