Topical Antibiotic Treatments

Antibiotics are typically described as antimicrobial agents of natural origin that are produced by microorganisms, which elicit a lethal or growth- 

Fleming s credited 1929 discovery of a fungal (common bread mold) metabolite from Pmicillium notatum that demonstrated potent bactericidal effects. Termed penicillin, this antibiotic was not isolated and purified until the period of World War II (1939-1945), when two scientists, 

Many antibacterial agents produce a clinically beneficial effect by in- 

Endospore-forming Bncillus bacterial species produce a chemical class of antibiotics known as polypeptides, including bacitracin and polymyxin 

Topical antibiotic treatments typically also include a local anesthetic (numbing agent), such as pramoxine hydrochloride, that interferes with the function of nerves that sense pain. 

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Patients with chronic bacterial conjunctivitis often have a concurrent case of blepharitis. Add a lid hygiene regimen to topical antibiotic treatment.12... 

The principal OTC pharmaceutical products include cold remedies, vitamins and mineral preparations, antacids, analgesics, topical antibiotics, antiftingals and antiseptics, and laxatives. Others include suntan products, ophthalmic solutions, hemorrhoidal products, sleep aids, and dermatological products for treatment of acne, dandmff, insect parasites, bums, dry skin, warts, and foot care products (11). More recent prescription-to-OTC switches have included hydrocortisone, antihistamine and decongestant products, antiftingal agents, and, as of 1995, several histamine H2-receptor antagonists. 

Topical antibiotics exert a direct local effect on specific microorganisms and may be bactericidal or bacteriostatic. Bacitracin (Baciguent) inhibits the cell wall synthesis. Bacitracin, gentamicin (G-myticin), erythromycin (Emgel), and neomycin are examples of topical antibiotics. These drugp are used to prevent superficial infections in minor cuts, wounds, skin abrasions, and minor burns. Erythromycin is also indicated for treatment of acne vulgaris. 

Mupirocin is a topical antibiotic that inhibits isoleucyl tRNA synthetase with the subsequent inhibition of protein synthesis. Mupirocin has become a mainstay in the treatment of Staph, aureus infection and colonization during hospital outbreaks, and it is in this organism that acquired resistance has arisen (Gilbart etal. 1993). 

Significant improvement of acute bacterial conjunctivitis should be seen within 1 week.11 Terminate treatment with topical antibiotics when the inflammation is resolved.12... 

Folliculitis, furuncles, and carbuncles refer to the inflammation of one or more hair follicles, often attributed to infection with S. aureus. Treatment depends on severity and may involve local heat, incision and drainage, and/or oral or topical antibiotic therapy. 

Systemic therapy with a variety of (3-lactams, macro-lides and lincosamides (clindamycin) has been the cornerstone of skin infection therapy for many years [17]. However, topical antibiotics can play an important role in both treatment and prevention of many primary cutaneous bacterial infections commonly seen in the dermatological practice [18], Indeed, while systemic antimicrobials are needed in the complicated infections of skin and skin structure, the milder forms can be successfully treated with topical therapy alone [18], The topical agents used most often in the treatment of superficial cutaneous bacterial infections are tetracyclines, mupirocin, bacitracin, polymyxin B, and neomycin. 

These data, taken together, demonstrate that topical application of rifaximin represents an effective and safe treatment of pyogenic skin infections. An additional application of this dermatological formulation would be infection prophylaxis in superficial skin wounds, particularly when used with a dressing that occludes the wound. Prophylactic topical antibiotic use makes particular sense for wounds in which the risk of infection is high, such as those that are likely to be contaminated (accidental wounds, lacerations, abrasions, and burns). Because all traumatic wounds should be considered contaminated, topical antibiotics are a logical measure to prevent wound... 

See Table 47-4 for systemic treatment of an infected pressure sore. A short, 2-week trial of topical antibiotic (silver sulfadiazine or triple antibiotic) is recommended for a clean ulcer that is not healing or is producing a moderate amount of exudate despite appropriate care. 

Another topical antibiotic, metronidazole, is effective in the treatment of acne rosacea. Metronidazole is a synthetic nitroimidazole derivative that reduces inflammation by an unknown mechanism. Other selected topical antibiotics are listed in Table 41.2. 

Nitrofurazone, a topical antibiotic, is occasionally used in the treatment of burns or skin grafts in which bacterial contamination may cause tissue rejection. 

Topical antibiotics are typically available as ointments and are excellent for use on open wounds. Coupled with the antibacterial action of the antibiotic ingredient, topical antibiotic ointments provide a safe and effective option in wound healing. In addition, topical antibiotics are effective for the localized treatment of primary and secondary pyodermas with minimal systemic side effects.14 Prophylactic uses include application for traumatic and surgical wounds, burns, intravascular catheters, and eradication of S. aureus nasal carriage.16 42 The advantage of antibiotic therapy in the treatment of eczematous skin will be discussed in the following article considering AD as an example. 

White, D.G., Collins, P.O., and Rowsell, R.B., Topical antibiotics in the treatment of superficial skin infections in general practice — a comparison of mupirocin with sodium fusidate. J. Infect. 18, 221-229, 1989. 

In about 2% to 4% of full-term newborns, the membrane over the valve of Hasner at the nasal end of the duct has not perforated. This causes a recurrent conjunctivitis and sometimes a dacryocystitis. Because spontaneous opening frequently occurs 1 to 2 months after birth, management is typically not aggressive. Warm compresses, massage from the canaliculi down over the lacrimal sac, and a topical antibiotic, if mucopurulent discharge is present, are usually prescribed for initial treatment (see Table 11-1). 

Topical antibiotic use in MOD is controversial. Some authors recommend against topical applications to avoid further disruption of the tear film and also because efficacy is questionable.Topical steroids are unlikely to have any benefit. During the course of therapy, attention should be given to the KCS that occurs in nearly every case. Artificial tears or lubricating ointments are indicated to ensure improvement in symptoms. More recent treatment options include topical cyclosporine A 0.05% as well as soft steroids such as loteprednol or rimexolone. 

Treatment consists of ocular lubrication for symptoms or signs of dry eye and treating any secondary bacterial infection with an appropriate topical antibiotic. Topical lubricants alone usually cannot control the symptoms of FES or LES. Preventing lid eversion generally requires lid taping or use of nocturnal eye shields.The definitive treatment, however, is surgical tightening of the eyelid and therefore requires an oculoplastics consult. 

Success in eradicating the infection also depends on removal of concretions and purulent material from the involved canaliculi. Actinomyces species are especially problematic in this regard, often forming casts within the canaliculus. These particles make it exceedingly difficult to treat cases of bacterial canaliculitis with topical medications alone in general, these dacryoliths must be removed before successful antibiotic treatment. In a few cases manual expression of the stones or casts is possible in others, canaliculotomy is required. In very resistant cases dacryocystorhinostomy may be necessary. 

Steroids are specifically contraindicated in the treatment of HSV conjunctivitis, because they can increase virus replication and interfere with the host immune response to the infection. Topical antibiotics are also of limited value in treating HSV. The risk of bacterial superinfection is low, and the potential toxic and hypersensitivity reactions associated with topical antibiotic use may obscure the clinical course of the underlying viral infection. 

The eyelid lesion is smooth with a central area of umbili-cation (Figure 25-17). Detection of some lesions may be difficnlt, becanse the eyelashes can obscnre them. Clinical manifestations of conjimctivitis inclnde the chronic and intermittent occnrrence of conjunctival hyperemia, tearing, and follicular hypertrophy of the lower tarsal conjimctiva. Symptoms frequently wax and wane, and patients often use multiple topical antibiotics and steroids without success. The treatment may allow... 

Topical antibiotic agents alone are inadequate and unnecessary when systemic treatment is administered. A single dose of ceftriaxone, 25 to 50 mg/kg intravenously or intramuscularly, not to exceed 125 mg, is the regimen currently recommended by the CDC. Simultaneous infection with C. trachomatis should be considered when a patient does not improve after treatment. Both mother and infent should be tested for chlamydial infection at the same time that gonorrhea testing is conducted. 

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