Antibiotics, Topical

Definition

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

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.

General Use

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. It is best to keep wounds clean and moist while they heal. The covering should still allow some air to reach the wound, however.

Precautions

The recommended dosage depends on the type of topical antibiotic. Parents should follow the directions on the package label or ask a pharmacist for directions before dressing their child's wound.

In general, topical antibiotics should be applied within four hours after injury. More than the recommended amount should not be used, and the antibiotic should not be applied more often than three times a day.

In the early 2000s many people 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 this development, 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 in order 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, the antibiotic should be discontinued and a doctor called.

Topical antibiotics should not be used 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 will not wash away
  • animal bites
  • deep puncture wounds
  • eye injuries

Regular topical antibiotics should never be used in the eyes. Special prescription 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. Parents should 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, the product should be discontinued immediately and a physician called.

As of 2004, no harmful or abnormal effects had 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 three 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.

Unless a parent is so advised by the childs' physician, topical antibiotics should not be used on children under two months of age.

Side Effects

The most common minor side effects of topical antibiotics 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, a doctor should be called 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 recommended the medication.

Parental Concerns

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. People should not use these two medicines at the same time unless told to do so by a healthcare 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

Books

Antibiotics: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References. San Diego, CA: Icon Health Publications, 2003.

Archer, Gordon, and Ronald E. Polk. "Treatment and Prophylaxis of Bacterial Infections." In Harrison's Principles of Internal Medicine, 15th ed. Edited by Eugene Braunwald et al. New York: McGraw-Hill, 2001, pp. 867-81.

Diasio, Robert B. "Principles of Drug Therapy." In Cecil Textbook of Medicine, 22nd ed. Edited by Lee Goldman et al. Philadelphia: Saunders, 2003, pp. 124-34.

Scott, Geoffrey M. Handbook of Essential Antibiotics. New York: Gordon & Breach Publishing Group, 2004.

Sherman, Josepha. War against Germs. New York: Rosen Publishing Group, 2004.

Periodicals

Chung, I., and V. Buhr. "Topical ophthalmic drugs and the pediatric patient." Optometry 71, no. 8 (2004): 511–8.

Haider, A., and J. C. Shaw. "Treatment of acne vulgaris." Journal of the American Medical Association 292, no. 6 (2004): 726–35.

Organizations

American Academy of Dermatology. 930 N. Meacham Road, PO Box 4014, Schaumburg, IL 60168-4014. Web site: www.aad.org/.

American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. Web site: www.aafp.org/.

American Academy of Pediatrics. 141 Northwest Point Blvd., Elk Grove Village, IL 60007-1098. Web site: www.aap.org/.

Web Sites

"Antibiotic Guide." Johns Hopkins Point of Care Information Technology. Available online at (accessed December 19, 2004).

"The Role of Topical Antibiotics in Dermatologic Practice." Medscape, June 25, 2003. Available online at (accessed December 19, 2004).

"Topical Antibiotics Are Effective in Bacterial Conjunctivitis." University of Michigan Department of Pediatrics. Available online at www.med.umich.edu/pediatrics/ebm/cats/conjunctivitis.htm (accessed December 19, 2004).

 


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