Stop using topical antibiotics

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Stop using topical antibiotics

Resistance to topical antibiotics is a growing concern. A local study found a rapid rise in resistance of Staphylococcus aureus to fusidic acid that paralleled prescribing in the community.1 

Expert opinion suggests stop using topical antibiotics (fusidic acid or mupirocin) for skin infections. In impetigo, antiseptic creams (iodine or hydrogen peroxide) may be as effective as topical antibiotics and oral antibiotics are indicated for treatment failure or multiple lesions. 

Infected eczema may need systemic antibiotics and improved eczema management (wet dressings, steroid cream) but topical fusidic acid or mupirocin are not indicated. 

Combination creams such as Pimafucort (hydrocortisone, natamycin and neomycin) and Fucicort (betamethasone and fusidic acid) are sometimes used when diagnosis is unclear, but their use also contributes to resistance. Consider a fungal scraping or a trial of a topical steroid or oral antibiotic depending on likely diagnosis. 

There may be a role for topical antibiotics for eradicating persistent nasal staph carriage (based on culture results) in patients with recurrent staph infections  (boils/furunculosis).2

This Gem has been checked by Associate Professor Mark Thomas, infectious diseases physician at Auckland City Hospital and Dr Emma Best, senior lecturer at the University of Auckland and paediatrician, specialist in infectious diseases.

References:

  1. High usage of topical fusidic acid and rapid clonal expansion of fusidic acid-resistant Staphylococcus aureus: a cautionary tale.
  2. BPAC: Should I prescribe a topical antiseptic cream instead of a topical antibiotic for minor skin infections? 

    Gems are chosen by the Goodfellow director Dr. Bruce Arroll to be either practice changing or practice maintaining. The information is educational and not clinical advice.

     
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