Topical Antibiotic Monotherapy

Topical Antibiotic Monotherapy Localized impetiginized eczema lesions can be treated successfully with topical fusidic acid or mupirocin, whereas topical application of other antibiotics (neomycin as obsolete aminoglycosid, tetracyclines, or polymyxines) should be avoided.84 Especially in children with AD, fusidic acid resistance seems to be a particular problem reflecting the chronicity and the extent of the disease (see Section 30.2.2). 

Antibiotics can be either administered topically — as monotherapy or as part of a combination therapy — or systemically. 

Antibiotics can be administered either systemic or topical as monotherapy or part of a corticoid-steroid combination. Antibacterial therapy leads not only to reduction of bacterial colonization, but also in many cases to improvement of AE, even when not actively infected 83,84... 

Erythromycin and clindamycin are the most common used topical antibiotics for the treatment of acne [14]. Topical antibiotics have a bacteriostatic and bactericidal effect, reducing P. acnes colonization of the sebaceous follicle. However, topical antibiotics have not to be used in monotherapy due to the high risk of increasing P. acnes resistance. The development of resistance is less frequent in patients who are treated with combination therapy (benzoyl peroxide/erythromycin benzoyl peroxide/clindamycin). These associations enhance the bactericidal effect, reducing the risk of drug-resistance. 

Blepharitis is a topical inflammation of the eyelid margins that should be treated using topical antibacterial agents. Gentamicin eye ointment is preferred to the fusidic acid drops since the ointment is a better formulation to be used where the condition involves the eyelid margins. Chloramphenicol eye drops is the third option since it is an antibiotic with a wider spectrum of activity. A combination of corticosteroid and antibiotic is not recommended because of the side-effects associated with the steroid. The use of oral tablets is not usually recommended since blepharitis can easily be managed with topical drops. The use of dexamethasone eye drops, monotherapy steroid, could clear the inflammation but mask persistence of infection. 

Treatment of microbial keratitis is started immediately irrespective of whether microbiologic evaluation has been performed. The best antimicrobial agent or agents to use initially is debated in the ophthalmic literature. The two main choices for initial antibiotic treatment are the combination of two fortified antibiotics, such as cefazolin and tobramycin, or monotherapy with topical fluoroquinolones. Just as with the decision to culture, the choice of antibiotic is often influenced by history and clinical presentation. Milder presentations, in low-risk... 

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