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Topical Antibiotics – Options in Dermatovenerology

The selection of the appropriate antibiotic should be made on the basis of the appearance of the skin lesion. Culture results and susceptibility testing of the isolated pathogens are needed within 48 hours. Topical antibiotics agents frequently have been used to prevent, as well as to suppress bacterial growth in open lesions. They has good place in dermatotherapy. They are the most common used agents in acne vulgaris, eczema, pyodermas, localized psoriasis, and for the most common skin disorders. The list is not exhaustive but is intended to provide an overview of the pharmacopoeia available. Their greatest usefulness has been when employed along with strict aseptic techniques in preventing percutaneous live sepsis. These agents are capable of inhibiting the local flora, but as is true of all antibiotics, they have a relatively limited spectrum of activity, which favors the emergence of bacterial resistance during treatment. Topical antibiotics may precipitate contact dermatitis and can be absorbed to toxic levels. However, even with broad-spectrum agents (sulfamylon-mafenide acetate cream or 0, 5% silver nitrate solution ), resistant species, such as clostridium perfringens, Klebsiella and Enterobacter, may emerge as the dominant potential pathogen of the local flora. For topical treatment as antiinfective agents there are desinfectans, oxidative agents, antibiotics, antimycotic and others. Topical antibiotics have respective place in dermatotherapy. Hydrogen peroxide, 5 to 20 volumes has been in wide use as a cleansing agent to remove purulent debris, it has a distinct antibacterial effect. Silver sulfadiazole is a sulfonamide derivate and is valuable in the management of chronic ulcers and burns. It has a good antistaphylococcal effect and sensitization is extremely rare. Selenium sulfide is a beneficial agent in the control of dandruff. In concentration of 2, 5 % suppression is useful for the treatment of tinea versicolor. It is effective for prophylaxis. Zinc Pyrithione Is an antifungal ant antibacterial agent. It is active ingredient in shampoos for the treatment seborrhoeic dermatitis of the scalp and in tinea versicolor used in much in the same way as selenium sulfide. Whitfield’ s ointment (12% benzoid acid and 6% salicylic acid) may be used in the treatment of dermatophytosis. It may, however cause irritation. Acetic acid (1-5%) is most useful topical antibacterial agent for Pseudomonas nail and toe web infections and bacitracin (500 unic per milliliter or gram) for selected superficial Staph. aureus and streptococcal lesions. Aminoglycosids were very long used in chronic wounds treatment, but contact allergy and resistant staphylococcus aureus strains are often too. Neomycin (0, 5% ointment) and Framycin, gentamicin (0, 17% cream) may be useful in selected patients when mixed gram-negative bacteria require local suppression, but have great allergic potential. Mupirocin (2% ointment) has antibacterial activity against various streptococci and staphylococcus aureus. It is safe and effective in the treatment of impetigo. Erythromycin is today most used topical antibiotic, especially for acne vulgaris. Clindamycin (Lincosamid) has similary effect as erythromycin in treatment of acne vulgaris. Tetracyclins are very often used topical antibiotics in the treatment of pyodermas. Fusidinic acid is very useful in staphylococcal infections and erythrasma, because fast penetration of fusidine through corneal layer and broad antibiotic spectrum action. Chloramphenicol is good topical antibiotic agent used in combination with others, but contact allergy is very often too. Polymyxin B is broad-spectrum antibiotic agent against gram-negative bacterias (Enterobacteriacea and Pseudomonas). Povidone-iodine (Betadine) is effective against the most gram – positive and gram- negative bacteria but does not persist in the skin to provide a residual action. Chlorhexidine gluconate (4% solution) is an antiseptic that combine broad antibacterial properties with prolonged action due to local accumulation. An alcoholic preparation is especially effective and generally is not irritating the skin. Broad-spectrum antiseptics can be used prophylactically or to treat local wounds and superficially infected dermatoses. The risk of long-term topical and systemic antibiotic use include the emergence of antibiotic-resistant bacteria and the suppression of normal bacteria flora, leading to overgrowth of pathogenic organisms such as Candida species and Clostridium difficile. Do individuals exposed to chronic topical antibiotic have an increased risk of developing contact allergy? This scientific workshop on topical antibacterial therapy will evaluate many important subjects areas. Antibiotic usage patterns in dermatology including hypersensitivity, alternative local therapy, indications and rational topical antibiotic therapy in dermatology.

Topical antibiotics; suppress bacterial growth; lesions

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