Antibacterials topical

Zink Pyrion 48%. [Ruetgm-Nease Pyrion-ChemieGmbH] Zinc pyridine-tidone antibacterial, topical an ngal, antiseixnrtieic. 

THERAP Cat (VET) Antibacterial, topically for eye and skin infections, orally for urinary tract. 

Nifuroxime. The anti form of the oxime prepared from 5-nitro-2-furancarboxaldehyde and hydroxylarnine, has been marketed for topical use as an antibacterial or an antifungal agent (1,17). 

NitrofuraZone. 2-[5-Nitro-2-furanyl)methylene]hydrazinecarboximide, the first nitrofiiran to be employed clinically, is prepared from 5-nitro-2-furancarboxaldehyde and semicarbazide (19). This product has seen clinical use topically as an antibacterial, for systemic appHcation for bacterial infections in poultry and swine, and also has been employed as a food additive. In rats, nitrofurazone is hydroxylated at the 4 position of the furan moiety (27). The involvement of nitrenium ions has also been postulated in the mechanism of action of nitrofurazone (38). 

There are hundreds of topical steroid preparations that are available for the treatment of skin diseases. In addition to their aforementioned antiinflammatory effects, topical steroids also exert their effects by vasoconstriction of the capillaries in the superficial dermis and by reduction of cellular mitosis and cell proliferation especially in the basal cell layer of the skin. In addition to the aforementioned systemic side effects, topical steroids can have adverse local effects. Chronic treatment with topical corticosteroids may increase the risk of bacterial and fungal infections. A combination steroid and antibacterial agent can be used to combat this problem. Additional local side effects that can be caused by extended use of topical steroids are epidermal atrophy, acne, glaucoma and cataracts (thus the weakest concentrations should be used in and around the eyes), pigmentation problems, hypertrichosis, allergic contact dermatitis, perioral dermatitis, and granuloma gluteale infantum (251). 

Deoxyribonuclease (DNAase), an enzyme that degrades deoxyribonucleic acid, has been used in patients with chronic bronchitis, and found to produce favorable responses presumably by degrading the DNA, contributed by cell nuclei, to inflammatory mucus (213). Lysozyme [9001 -63-2] hydrolyzes the mucopeptides of bacterial cell walls. Accordingly, it has been used as an antibacterial agent, usually in combination with standard antibiotics. Topical apphcations are also useful in the debridement of serious bums, cellulitis, and dermal ulceration. 

P01CC02 S01AX04 S02AA02 Use antiseptic, topical antibacterial... 

Gentian violet solution is used to delineate the areas to be treated. Refrigerant topical anesthesia is used to freeze the skin prior to the procedure. Holding the skin taut, the dermabrader treats one anatomic unit at a time. Post-operatively, patients may have an open or closed dressing system, use antiviral agents, antibacterials and corticosteroids. The re-epithelialization is complete in 5-7 days and residual erythema is common for up to 4 weeks. 

Of these, noxythiolin (N-hydroxy-Af-methylthiourea) has the greatest pharmaceutical use as an antimicrobial agent. The compound is supplied as a dry powder and on aqueous reconstitution slowly releases formaldehyde and iV-mefhylthiourea. Antimicrobial activity is considered to be due to both the noxythiolin molecule and the released formaldehyde. Noxythiolin is used both topically and in accessible body cavities as an irrigation solution and in the treatment of peritonitis. The compound has extensive antibacterial and antifungal properties. 

Retinoids, which are highly effective in the treatment of acne, stimulate epithelial cell turnover and aid in unclogging blocked pores. Retinoids also exhibit anti-inflammatory properties through the inhibition of neutrophil and monocyte chemotaxis.8 Because of these comedolytic and antiinflammatory effects, topical retinoids are recommended as first-line treatment for mild to moderate comedonal and inflammatory acne.3 While success is seen with monotherapy, using a retinoid in combination with benzoyl peroxide or topical antibacterials is also an appropriate and effective therapeutic treatment option.3 Tretinoin, adapalene, and tazarotene are topical retinoids available for use in the treatment of acne. Table 62-2 describes the strengths and formulations of these agents. 

Topical antibacterials directly suppress P. acnes and are also first-line agents used in the treatment of mild to moderate inflammatory acne.3,16... 

Clindamycin 1% and erythromycin 2% preparations, applied once or twice daily, have similar effects and are the most commonly prescribed topical antibacterial agents.17 These agents, as well as sodium sulfacetamide, are available in various formulations for the treatment of acne. 

Adverse effects are generally mild and include dryness, erythema, and itching.18 Although rare and seen most often with oral therapy, pseudomembranous colitis can occur with the use of topical clindamycin.19 As with any antibacterial agent, the possibility of resistance exists with the use of topical erythromycin. However, co-administration of erythromycin and benzoyl peroxide has been shown to decrease the incidence of resistance, as well as to improve symptoms of mild to moderate inflammatory acne.20... 

With antibacterial and anti-inflammatory properties, and the ability to stabilize keratinization, azelaic acid is an effective alternative in the treatment of mild to moderate acne in patients who cannot tolerate benzoyl peroxide or topical retinoids.3,21 It also has a hypopigmentation effect that may prove effective in patients who are prone to post-inflammatory hyperpigmentation resulting from acne.22... 

If conventional treatment fails, unresolved diaper rash can also lead to secondary bacterial infections. Staphylococcus aureus and streptococci are the most likely pathogens responsible for these infections and require treatment with systemic antibiotics.3 37 While topical protectants may be used as an adjunct in treatment, suspected bacterial infections should always be referred to a physician for accurate diagnosis and the selection of an appropriate antibacterial regimen.34 Figure 62-7 shows a useful algorithm for the effective treatment of diaper dermatitis. 

Silver and mercury salts have a long history of use as antibacterial agents.241-243 The use of mercurochrome ((40), Figure 18) as a topical disinfectant is now discouraged. Silver sulfadiazene (38) finds use for treatment of severe burns the polymeric material slowly releases the antibacterial Ag+ ion. Silver nitrate is still used in many countries to prevent ophthalmic disease in newborn children.244 The mechanism of action of Ag and Hg is through slow release of the active metal ion—inhibition of thiol function in bacterial cell walls gives a rationale for the specificity of bacteriocidal action. 

Due to the frequent difficulty of doing cultures before giving an antibacterial drug, topical treatment often requires the use of broad-spectrum antibiotics. However, the selection of resistant strains, especially via the use of broad-spectrum antimicrobials with marked systemic dif-... 

The broad antibacterial activity of rifaximin as well as its topical action make this antibiotic suitable for intrapocket administration in periodontal disease. As a matter of fact, local application of rifaximin compares well with tetracyclines and metronidazole in other extra-GI diseases, i.e. skin infections and BY, respectively (see above). On the other hand, rifampicin (rifampin), another rifamy-cin derivative, has been successfully used in the treatment... 

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