Antibiotics, Topical

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Antibiotics, Topical

 

Definition

Topical antibiotics are medicines applied to the skin to kill bacteria.

Purpose

Topical antibiotics help prevent infections caused by bacteria that get into minor cuts, scrapes, and burns. Treating minor wounds with antibiotics allows quicker healing. If the wounds are left untreated, the bacteria will multiply, causing pain, redness, swelling, itching, and oozing. Untreated infections can eventually spread and become much more serious.
Different kinds of topical antibiotics kill different kinds of bacteria. Many antibiotic first-aid products contain combinations of antibiotics to make them effective against a broad range of bacteria.
When treating a wound, it is not enough to simply apply a topical antibiotic. The wound must first be cleaned with soap and water and patted dry. After the antibiotic is applied, the wound should be covered with a dressing, such as a bandage or a protective gel or spray. For many years, it was thought that wounds heal best when exposed to the air. But now most experts say it is best to keep wounds clean and moist while they heal. The covering should still allow some air to reach the wound, however.

Description

Some topical antibiotics are available without a prescription and are sold in many forms, including creams, ointments, powders, and sprays. Some widely used topical antibiotics are bacitracin, neomycin, mupirocin, and polymyxin B. Among the products that contain one or more of these ingredients are Bactroban (a prescription item), Neosporin, Polysporin, and Triple Antibiotic Ointment or Cream.

Recommended dosage

The recommended dosage depends on the type of topical antibiotic. Follow the directions on the package label or ask a pharmacist for directions.
In general, topical antibiotics should be applied within four hours after injury. Do not use more than the recommended amount and do not apply it more often than three times a day. Do not apply the medicine over large areas of skin or on open wounds.

Precautions

Many public health experts are concerned about antibiotic resistance, a problem that can develop when antibiotics are overused. Over time, bacteria develop new defenses against antibiotics that once were effective against them. Because bacteria reproduce so quickly, these defenses can be rapidly passed on through generations of bacteria until almost all are immune to the effects of a particular antibiotic. The process happens faster than new antibiotics can be developed. To help control the problem, many experts advise people to use topical antibiotics only for short periods, that is, until the wound heals, and only as directed. For the topical antibiotic to work best, it should be used only to prevent infection in a fresh wound, not to treat an infection that has already started. Wounds that are not fresh may need the attention of a physician to prevent complications such as blood poisoning.
Topical antibiotics are meant to be used only on the skin and only for only a few days at a time. If the wound has not healed in five days, stop using the antibiotic and call a doctor.
Do not use topical antibiotics on large areas of skin or on open wounds. These products should not be used to treat diaper rash in infants or incontinence rash in adults.
Only minor cuts, scrapes, and burns should be treated with topical antibiotics. Certain kinds of injuries may need medical care and should not be self-treated with topical antibiotics. These include:
  • large wounds
  • deep cuts
  • cuts that continue bleeding
  • cuts that may need stitches
  • burns any larger than a few inches in diameter
  • scrapes imbedded with particles that won't wash away
  • animal bites
  • deep puncture wounds
  • eye injuries
Never use regular topical antibiotics in the eyes. Special antibiotic products are available for treating eye infections.
Although topical antibiotics control infections caused by bacteria, they may allow fungal infections to develop. The use of other medicines to treat the fungal infections may be necessary. Check with the physician or pharmacist.
Some people may be allergic to one or more ingredients in a topical antibiotic product. If an allergic reaction develops, stop using the product immediately and call a physician.
No harmful or abnormal effects have been reported in babies whose mothers used topical antibiotics while pregnant or nursing. However, pregnant women generally are advised not to use any drugs during the first 3 months after conception. A woman who is pregnant or breastfeeding or who plans to become pregnant should check with her physician before using a topical antibiotic.

Key terms

Bacteria — Tiny, one-celled forms of life that cause many diseases and infections.
Conception — The union of egg and sperm to form a fetus.
Fungal — Caused by a fungus.
Fungus — A member of a group of simple organisms that are related to yeast and molds.
Incontinence — The inability to control the bladder or bowel.
Inflammation — Pain, redness, swelling, and heat that usually develop in response to injury or illness.
Unless a physician says to do so, do not use topical antibiotics on children under two years of age.

Side effects

The most common minor side effects are itching or burning. These problems usually do not require medical treatment unless they do not go away or they interfere with normal activities.
If any of the following side effects occur, check with a doctor as soon as possible:
  • rash
  • swelling of the lips and face
  • sweating
  • tightness or discomfort in the chest
  • breathing problems
  • fainting or dizziness
  • low blood pressure
  • nausea
  • diarrhea
  • hearing loss or ringing in the ears
Other rare side effects may occur. Anyone who has unusual symptoms after using a topical antibiotic should get in touch with the physician who prescribed or the pharmacist who recommedned the medication.

Interactions

Using certain topical antibiotics at the same time as hydrocortisone (a topical corticosteroid used to treat inflammation) may hide signs of infection or allergic reaction. Do not use these two medicines at the same time unless told to do so by a health care provider.
Anyone who is using any other type of prescription or nonprescription (over-the-counter) medicine on the skin should check with a doctor before using a topical antibiotic.

Resources

Periodicals

Farley, Dixie. "Help for Cuts, Scrapes and Burns." FDA Consumer May 1996:12.
References in periodicals archive ?
The five recommendations from 2013 were to avoid oral antifungal therapy for suspected nail fungus until infection has been confirmed; to refrain from further staging studies, such as sentinel lymph node biopsy, in early stage, localized melanoma; to refrain from Mohs micrographic surgery in nonmelanoma skin cancer of less than 1 cm in size; to avoid oral antibiotics for atopic dermatitis in the absence of clinical evidence of infection, and to avoid topical antibiotics for infection prophylaxis for clean surgical wounds.
An active education program was undertaken on the appropriate use of topical antibiotics, and a repeat audit was done over the same 4-month period in 2004.
A 14-year-old girl presented with a long-standing history of right aural fullness, otalgia, hearing loss, and recurrent otorrhea that had been unresponsive to multiple courses of oral and topical antibiotics. Because cholesteatoma had been suspected during a previous evaluation, she had undergone a right intact canal wall tympanomastoidectomy; however, this procedure failed to alleviate her symptoms.
The use of oral antibiotics has been associated with the development of resistance in normal flora at all body sites, whereas the resistance that develops from exposure to topical antibiotics generally is limited to the site of application.
Topical antibiotics have a great advantage over other dosage forms with respect to the higher concentration of medication that can be delivered.
Recent studies about the treatment of acne address antibiotic dosing, maintenance therapy, topical antibiotics and benzoyl peroxide in facial and trunkal acne, the link between antibiotics and risk of inflammatory bowel disease, and the role of diet in acne.
Treatment of granuloma in the tubes may require topical antibiotics with steroids, and systemic antibiotics may be needed.
Moreover, the higher incidence of complications and side effects associated with topical antibiotics other than quinolones might also result in higher costs.
When skin superinfection is present, both oral and topical antibiotics can be highly effective.
Treatment several times a day with topical antibiotics for a few days may help.
"One of the reasons people don't typically use topical antibiotics for ear infections is you have to wick the ear first--not many families want to do that 3 or 4 times a day," said Dr.