What Topical Antibiotics are Best for Dermatological Conditions?

🔍 Key Finding This review summarizes the common topical antibiotics used in dermatology, including their mechanisms of action, clinical indications, and emerging resistance patterns, to guide dermatologists in choosing the most appropriate therapy for various skin infections and inflammatory dermatoses. It emphasizes the importance of antibiotic stewardship to mitigate the growing problem of antibiotic resistance.

🔬 Methodology Overview

• Design: Literature review.
• Data Sources: PubMed and Google Scholar.
• Selection Criteria: English-language articles published between 1965-2022 on topical antibiotics, skin infections, dermatology, antimicrobials, and inflammatory dermatoses.
• Analysis Approach: Qualitative summary of information regarding common topical antibiotics used in dermatology, including their indications, mechanisms of action, efficacy, and adverse events.
• Scope: Topical antibiotic use in dermatology.

📊 Results

• Topical antibiotics are effective for various dermatological conditions like acne, wound infections, and impetigo.
• Bacterial resistance is a concern with topical antibiotic use, necessitating careful prescribing practices.
• Azelaic acid inhibits tyrosinase and has antimicrobial and anti-inflammatory properties, effective for acne and rosacea.
• Benzoyl peroxide is bactericidal against C. acnes and other Gram-positive organisms, but not Gram-negative bacteria.
• Topical clindamycin effectively treats acne by inhibiting C. acnes growth, but resistance is increasing (44.1% in Japan 2016-2017).
• Mupirocin resistance in MRSA ranges from 1-81% globally, driven by factors like over-the-counter availability and increased use for surgical prophylaxis.
• Ozenoxacin is a newer topical antibiotic effective against impetigo, with activity against some mupirocin- and ciprofloxacin-resistant S. aureus.

💡 Clinical Impact This review comprehensively summarizes the spectrum of topical antibiotics used in dermatology, including their mechanisms, indications, and resistance profiles, enabling clinicians to make informed choices for various skin infections and inflammatory dermatoses. This information promotes judicious antibiotic selection and stewardship, crucial for minimizing resistance development and optimizing patient outcomes.

🤔 Limitations

• Emergence of bacterial resistance to topical antibiotics.
• Limited ability to target deep wounds.
• Potential to induce contact dermatitis.
• Alteration of the cutaneous microbiome with prolonged exposure.
• Potential changes to the bacteriology of the nares and oropharynx.
• Limited research on cross-reactivity and contact allergies.
• Insufficient large-scale clinical trials on botanical product alternatives.

✨ What It Means For You Dermatologists should strategically select topical antibiotics based on the specific skin infection, patient age, and potential for resistance, considering newer options like ozenoxacin and retapamulin for impetigo given rising mupirocin resistance. Clinicians must also educate patients on proper use and duration to minimize resistance development and monitor for adverse events, including contact dermatitis and, rarely, systemic effects like pseudomembranous colitis.

Reference Dallo M, Patel K, Hebert AA. Topical Antibiotic Treatment in Dermatology. Antibiotics. 2023;12:188. https://doi.org/10.3390/antibiotics12020188