Where Can U Get Antibotic Cream or Ointments
April 01, 2002
5 min read
Topical products used for the treatment of mutual skin infections
This calendar month's cavalcade discusses common bacterial skin infections and the proper forms and dosages of treatment.
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Numerous topical antiinfective products are available to your patients over-the-counter (OTC) or by prescription. Not simply tin can the agile antiinfective agents differ among these products, only their pharmaceutical dosage grade (ie, ointment or foam) may as well. The indications for topical antiinfectives, including acne vulgaris, various fungal skin infections, or viral skin infections (eg, herpes simplex virus) are too wide to discuss in this cavalcade. Discussed in this month's column will be the handling of common bacterial peel infections, including impetigo, with topical antiinfectives.
Labeling for the various topical antibiotics includes numerous potential uses, including furunculosis and ecthyma, although their benefit, equally proven by controlled clinical trials, is limited. Dermatology references more often than not recommend topical antibiotics as an option of therapy for impetigo, superficial folliculitis, furunculosis (afterward incision and drainage), and minor abrasions. Treatment of other pyodermas, such as carbuncles, ecthyma, cellulitis or erysipelas, are best treated with systemic antibiotics.
Pharmaceutical dosage forms
Topical antibiotics are usually available in two pharmaceutical dosage forms, ointments or creams. Ointments are semisolid preparations (water-in-oil) that are generally more occlusive (preventing the escape of moisture) and more than difficult to remove from the skin once applied. While there are unlike ingredients comprising ointments, many contain petrolatum. Petrolatum is an excellent occlusive agent, and thus, functions as an emollient (for water is the most important epidermal plasticizer) and lubricant. Patients may notice petrolatum messy, notwithstanding. Ointments, due to their occlusive furnishings, are all-time used for peel disorders with associated dryness, and not for areas with oozing lesions.
Creams are also semisolid preparations (oil-in-water) that are mostly not as occlusive equally ointments. Creams are generally not every bit messy as ointments, can be washed off with water, and patients may prefer these dosage forms because of this. As the ratio of oil content increases to the amount of water present, semisolid preparations evolve from creams to ointments.
From a practical standpoint, it is helpful to have an appreciation for the amount of cream or ointment necessary to treat a specific infected area of skin. If not enough medication is prescribed, patients may apply as well little or may non obtain more medication by refill. One gram of cream will adequately cover approximately a ten cm x 10 cm (100 cm2) surface area of skin; a like amount of ointment will cover an area 5%-10% larger. A unit of measurement referred to as the fingertip unit (FTU) tin be used to guess how much medication to use. An FTU (developed), the area from the distal pare crease to the index finger tip, is approximately equivalent to 0.5 k. Viewed another mode, the expanse of peel on 1 developed flat, closed hand would be covered by 0.5 FTU (0.25 yard) of ointment.
Impetigo
The nearly common awarding of topical antibiotics for active infection in the pediatric patient is probably for use in the therapy of impetigo. 2 forms of impetigo – bullous and nonbullous – require different treatments. Bullous impetigo, while not equally common as the nonbullous form, requires the use of systemic antibiotics. The bacterial cause of bullous impetigo is Staphylococcus aureus, which produces an epidermolytic toxin. Bullous impetigo is best treated with a systemic antibody that provides activity toward this pathogen, such as dicloxacillin, some cephalosporins (eg, cephalexin or cefuroxime), or clindamycin.
| It is helpful to have an appreciation of the corporeality of cream or ointment needed to treat a specific infected expanse: 1 g of foam will cover well-nigh a 10 cm ten x cm area of skin; 1 thou of ointment volition cover an area 5%-10% larger. |
Nonbullous impetigo results from infection with Streptococcus pyogenes, Staphylococcus aureus or both. If nonbullous impetigo is not all-encompassing or involving the rima oris area, topical antibiotics can finer be used. All-encompassing infection can exist treated with oral antibiotics.
While several topical antibody preparations can be used, such as bacitracin, triple antibody ointment (polymixin B, neomycin, bacitracin), or gentamicin, mupirocin (Bactroban, GlaxoSmithKline) is ofttimes recommended. Mupirocin is a unique antibody produced from Pseudomonas florescens and is active toward Streptococcus and Staphylococcus, including methicillin-resistant S. aureus (MRSA). Double-blind clinical studies have proven mupirocin to exist as constructive equally orally administered erythromycin, and superior to uncomplicated cleaning of lesions. Mupirocin has not been evaluated by controlled trials when compared with other topical antibiotics or other antistaphyloccal oral antibiotics. Mupirocin is available in an ointment formulation (in a water miscible base) and is canonical for the handling of impetigo in children 2 months to xvi years of historic period. A cream formulation is also available, canonical for ages 3 months to xvi years, to treat secondarily infected traumatic pare lesions. Controlled clinical trials accept compared mupirocin cream to cephalexin and found equal efficacy. Mupirocin has not been compared with other topical antibacterials for secondarily infected traumatic skin lesions. Bactroban is relatively expensive when compared with the other topical antibacterials discussed here.
Mupirocin is likewise bachelor in a unique conception indicated for the eradication of nasal colonization of MRSA in adults (12 years and older) to reduce the chance of infection amidst susceptible individuals (during institutional outbreaks). It has too been recommended in the literature to use mupirocin nasally to eliminate colonization to preclude recurrent impetigo, which may be due to nasal colonization. Clinical trials evaluating this use, nevertheless, have not been performed. Bactroban Nasal, available in one g single-utilize tubes, should be applied by administering i one-half of the tube corporeality to each nostril twice daily for v days. Later awarding the patient should be instructed to repeatedly press the nostrils together for one minute, as this spreads the ointment within the nostrils.
Appropriate cleansing of minor wounds with antibacterial soaps and awarding of OTC topical antibacterial products may also be beneficial to prevent recurrent impetigo.
Additional uses of topical antibiotics
Several antibacterial agents are available in OTC or prescription products. OTC products may incorporate bacitracin, neomycin, polymixin B, or a combination of all iii (triple antibody products), and can be useful for the treatment of minor abrasions and may perhaps prevent the development of recurrent impetigo.
Bacitracin, active toward gram-positive leaner, is available in ointment formulations and is relatively cheap. Neomycin, an aminoglycoside, is active toward many gram-negative pathogens.
A meaning disadvantage to the utilize of neomycin relates to its relatively high propensity to cause allergic contact sensitivity reactions. Take a chance of such reaction increases with prolonged use. Polymixin B provides activity toward gram-negative pathogens and is available in combination with bacitracin and neomycin. Gentian violet solution is besides available OTC for the treatment of modest abrasions. Its use may cause staining of the skin or clothing. Gentamicin is an aminoglycoside available by prescription in ointment and cream formulations. It is infrequently mentioned in the literature as recommended therapy for common skin infections.
Conclusion
In conclusion, topical antibiotic products can effectively treat infected traumatic skin lesions and nonbullous impetigo, assuasive patients the choice of an optional therapy where systemic drug adverse furnishings (such as diarrhea) are eliminated. Mupirocin is every bit efficacious as oral erythromycin in the handling of localized nonbullous impetigo. OTC topical antibiotic products are inexpensive options for treating secondarily infected traumatic skin lesions. Mupirocin, a relatively more expensive option, may offer no benefit for this use.
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For more information:
- Jain A. Staphylococcal infections. Pediatrics in Review. 1999;20:183-81
- Hirschmann JV. Topical antibiotics in dermatology. Athenaeum of Dermatology. 1988;124:1691-1700
- Dagan R. Impetigo in childhood: irresolute epidemiology and new treatments. Ped Register 1993;22:235-40
- Britton JW. Comparison of mupirocin and erythromycin in the treatment of impetigo. J Pediatrics. 1990;117:827-9
Source: https://www.healio.com/news/pediatrics/20120325/topical-products-used-for-the-treatment-of-common-skin-infections
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