Home Books Fitzpatrick's Dermatology in General Medicine, 8e

Chapter 218. Topical Antibiotics

Mark W. Bonner; William D. James

Topical Antibiotics at a Glance

Topical antibiotics are useful in the treatment of acne and rosacea.
Use in impetigo may obviate the need for oral antibiotics.
Use of topical antibiotics to prevent wound infection after clean surgical procedures is unnecessary.

Topical antibiotics play an important role in the management of many common dermatologic conditions (Table 218-1). They are prescribed most often by dermatologists for the management of mild-to-moderate acne vulgaris or as adjunctive treatment with oral agents. For localized superficial infections, such as impetigo, the use of a topical agent (e.g., mupirocin or retapamulin) may eliminate the need for oral antibiotics and the accompanying problems of compliance, gastrointestinal side effects, and potential drug interactions. Topical antibiotics are still frequently prescribed as prophylactic agents after minor surgery or cosmetic procedures (chemical peel or laser resurfacing) to reduce the risk of postoperative wound infection and to speed wound healing. The use of topical antibiotics for prophylaxis after such minor procedures has been proven to be unnecessary and incurs risk of inducing allergy. Petrolatum is recommended for use after clean surgical procedures.

Table 218-1 Topical Antibiotics

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Table 218-1 Topical Antibiotics

Name

Form Available

Mechanism of Action

Bacteriaa

Bacitracin

Cell wall inhibitor

Gr+

Polymyxin B

Detergent

Gr–

Gramicidin

Ion channel

Gr+

Mupirocin

O, C

Transfer RNA inhibitor

Gr+

Neomycin

30S ribosome inhibition

Gr−

Erythromycin

S, G, P, O

50S ribosome inhibition

Gr±

Clindamycin

S, G, L

50S ribosome inhibition

Fusidic acid

Interferes with EF-G

Silver sulfadiazine

Mafenide acetate

Enzyme inhibition

Gr±

Nitrofurazone

C, S

Enzyme inhibition

Gr±

Metronidazole

G, C, L

Electrochemical

Anaerobes

Clioquinol

C, O

Unknown

Broad spectrum

Azelaic acid

C, G

Protein synthesis inhibition

Gr+

C = cream; EF-G = elongation factor G; G = gel; Gr+ = Gram-positive; Gr– = Gram-negative; Gr± = Gram-positive or -negative; L = lotion; NA = not available in the United States; O = ointment; P = pledget; S = solution.

aBacteria refers to bacteria usually susceptible to antibiotic.

The efficacy of topical antibiotics for the treatment of acne vulgaris and rosacea may be due to their direct antibiotic effect, but many of the topical antibiotics exhibit anti-inflammatory properties by suppressing neutrophil chemotactic factor or by other mechanisms.1 There are concerns about the use of topical antibiotics in the treatment of acne vulgaris because of the increasing levels of antibiotic resistance. Combining the antimicrobial benzoyl peroxide with antibiotics reduces the development of antibiotic resistance.

Erythromycin

Erythromycin belongs to the group of macrolide antibiotics and is active against both Gram-positive cocci and Gram-negative bacilli. It is used principally as a topical agent in the treatment of acne. Erythromycin binds to the bacterial 50S ribosome and blocks translocation of the peptidyl-transfer RNA (tRNA) molecule from the acceptor to the donor site, interfering ...

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