Semin Cutan Med Surg. Jun;35(2) doi: /freshtag.me Topical and oral antibiotics for acne vulgaris. Del Rosso JQ(1)(2). Cutis. Aug;82(2 Suppl 2) Topical and oral antibiotics in wound care. Hirschmann JV(1). Author information: (1)Division of General Internal Medicine. Dr. Lawrence Eichenfield addresses a question about when to use topical antibiotics concomitantly with oral antibiotics in the treatment of acne.
Oral Topical Antibiotics &
The bacteriology of chronic venous ulcers treated with occlusive hydrocolloid dressings. The bacterial flora of chronic venous ulcers treated with an occlusive hydrocolloid dressing were studied over a period of 8 weeks. A novel exudate sampling method was used in an attempt to isolate anaerobic bacteria.
The flora was generally stable. Once a species was present, it remained with the exception of Pseudomonas, which appeared to be inhibited by the dressing. Twelve out of 20 ulcers contained anaerobic bacteria and healing did not appear to be impaired by the presence of any particular species of bacteria. The natural history of streptococcal skin infection: Prevention with topical antibiotics.
An investigation on the natural history of streptococcal skin infection was done in fifty-nine children in a rural day care setting. A double-blind study for prevention of streptococcal pyoderma was done during the peak season for skin infection. Triple antibiotic ointment, containing bacitracin, polysporin, and neomycin, was compared to placebo ointment. Ointments were applied thrice daily for minor skin trauma; mosquito bites and abrasions were predominant.
Cultures of normal skin surfaces were taken for group A streptococci each week of the week study period. Skin lesions were cultured whenever present. Eighty-one percent of the fifty-nine patients had positive normal skin cultures on one or more occasions. This study further confirms the importance of skin carriage of group A streptococci as a precursor to pyoderma and demonstrates the importance of minor skin trauma as a predisposing factor.
Topical antibiotics may be useful in preventing streptococcal pyoderma, especially in children known to be at increased risk for such infection. Systemic administration of antibiotics in the management of venous ulcers. A randomized clinical trial. Forty-seven patients with chronic venous leg ulcers were included in a randomized clinical trial to evaluate the efficacy of systemically administered antibiotics in healing with condition. One group was treated by means of elastic support bandages only, whereas the other one received the same local treatment plus systemic antibiotics.
No statistically relevant difference was noted between the two groups in healing rates of ulcers or in changes of the microbiologic flora. The results of our study do not support the routine administration of systemic antibiotics in the management of chronic venous leg ulcers. The importance of pathogenic bacteria in venous leg ulcers was analysed in a randomized open trial divided into 2 parts.
During the first 2-week period the effects of physiological saline and dextranomer beads were compared. During the following 8 weeks the effect of porcine skin, aluminium foil and a double layer bandage were compared.
The assessment of the results of treatment was based on the area and volume of the ulcer measured by stereophotogrammetry and the bacteriological findings. Staphylococcus aureus was the commonest isolated species.
Mixed cultures comprising Staph. Environmental measures should include cleaning of regularly touched surfaces and frequent washing of clothes, towels and linen. If the patient continues to have recurrent skin infections despite optimal care and hygiene measures, personal decolonisation with antibiotics may be required and also considered for family members.
Consider discussing an appropriate decolonisation regimen with an infectious diseases expert as advice is likely to vary due to local resistance patterns.
There is a lack of consensus on the most effective decolonisation method and increasing antibiotic resistance continues to drive research into alternative options both in New Zealand and internationally. For example, the antiseptic povidone-iodine used intranasally has been suggested as an alternative to a topical antibiotic, but consistent evidence for its effectiveness is lacking. Topical antibiotic treatment — if topical antibiotics are recommended, the appropriate topical antibacterial either mupirocin or fusidic acid as guided by the sensitivity results should be applied to the anterior nares, twice daily, for five to seven days.
They should not be administered if the patient still has an active skin infection as the skin infection can be a source from which nasal carriage is re-established. Good personal hygiene measures and environmental decolonisation measures should be ongoing. Oral antibiotic treatment — although international guidelines do not recommend the routine use of oral antibiotics for decolonisation there may be a role for this strategy when first-line measures have been unsuccessful or when there is active infection.
This can be obtained from an infectious disease specialist or a clinical microbiologist at a community laboratory and the prescription endorsed accordingly. Folliculitis is a collective term for a group of skin conditions which can be due to bacterial infection but can be also caused by fungi and viruses. A sterile folliculitis can be the result of occlusion, e. Superficial folliculitis is a mild, self-limiting condition and patients usually do not require topical or oral antibiotic treatment.
Management should focus on effective skin hygiene, avoiding or treating any underlying cause and topical antiseptics. Larger lesions such as furuncles and carbuncles that extend into the subcutaneous tissue and are fluctuant should be managed with incision and drainage alone. Patients do not usually need antibiotic treatment unless there is associated cellulitis or the patient becomes systemically unwell.
Although management for skin infections in primary care cannot be directed by a conclusive evidence base, the consensus from infectious diseases experts is that, given the rise in antibacterial resistance rates in New Zealand, topical antiseptics and education about good skin hygiene practices presents a pragmatic approach when managing patients with skin infections. Inappropriate use of topical antibiotics has been clearly shown to be associated with rapidly rising resistance.
Clinicians need to be mindful of this and alter their management accordingly. We have now added the ability to add replies to a comment. Simply click the "Reply to comment" button and complete the form. Your reply, once signed off, will appear below the comment to which you replied if multiple replies to a comment, they will appear in order of submission.
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Topical antibiotics for skin infections: Please login to save this article. What prescribers need to know: Our initial sample size calculation was based on a clinically important difference of 3 in POEM score and a common standard deviation of 7. In April , we used the data from the first 69 participants to revisit some of the parameters in the sample size calculation. Using the standard deviation from the baseline POEM scores 5.
We used rules on missing data from the score questionnaire developers Supplemental Appendix 3, available at http: Daily symptom scores were added to create a total daily symptom severity score. Mean daily symptom scores for each group were plotted and compared using area-under-the-curve analyses. Topical corticosteroids were classified as mild, moderate, potent, or very potent using British National Formulary classification.
We converted data on adverse effects to a binary variable using slight problem or worse as a cut-point, and we compared the odds of experiencing any adverse effect in each of the treatment groups with those in the control group. We also conducted sensitivity analyses to assess for efficacy while controlling for adherence Complier Average Casual Effect [CACE] and to assess potential information bias from missing data multiple imputation.
A CACE analysis aims to estimate the causal effects of the intervention in those individuals who comply with adhere to treatment, and is recommended over per-protocol analyses. The full trial protocol is available as a supplementary file Supplemental Appendix 4, available at http: Ninety-four sites 90 general practices and 4 hospital dermatology clinics were opened between July and November , and of these, 33 32 general practices and 1 dermatology clinic recruited 1 or more participants.
Participating sites were slightly larger than non-participating practices mean practice list size 9, vs 6, , but there were no significant differences in number of partners, proportion of list aged 8 years or less, or proportion of children aged 8 years or less who have eczema.
One hundred thirteen participants were randomized Supplemental Appendix 5, available at http: Three participants had penicillin allergy, but none were randomized to the oral antibiotics group, so no participants received oral erythromycin.
There were no significant differences in baseline characteristics among the 3 groups Table 1. POEM scores were similar in the 3 groups at baseline, and reduced improved in all 3 groups by 2 weeks Table 2. POEM scores at 4 weeks and 3 months, and other secondary outcomes, all suggested no or minimal clinical benefit from oral or topical antibiotics Table 2 and Supplemental Appendix 6, available at http: Total daily symptom scores decreased over the first week and then stayed relatively stable Supplemental Appendix 7, available at http: There were no significant differences in reported use of topical corticosteroids Table 3.
Adjusting for medication use or missing data did not affect the results Supplemental Appendix 8, available at http: Seventy percent of patients had S. No serious adverse events were reported.
New rash, diarrhea, and vomiting were the most common adverse events reported, experienced by There were no notable differences by treatment group Supplemental Appendix 10, available at http: In this study, children with clinically infected eczema flares in primary care recovered quickly with use of mild-to-moderate—strength topical corticosteroids and did not benefit from the addition of either oral or topical antibiotics.
We have conducted the largest trial to evaluate the effect of oral and topical antibiotic treatment for clinically infected eczema in children and the only such trial to be conducted in ambulatory care, where most children with eczema flares are treated. Randomization was conducted independently, we used matched placebos, and there were no breaches in allocation concealment.
We found no evidence of differential use of medications, including topical corticosteroids, and adjusting for compliance did not alter our findings. Blinded outcome assessors used well-validated instruments to assess subjective and objective eczema severity at baseline and at follow-up. We achieved high rates of follow-up, and our primary analysis was by intention to treat. Analysis of longer-term follow-up and analyses controlling for missing data were all consistent with our main finding that neither topical nor oral antibiotics offer any clinically important benefit.
There is no standard definition of infected eczema, so we used pragmatic inclusion criteria based on clinical suspicion of infection. Included children were clearly experiencing flares in their eczema, considering that their mean baseline POEM scores were higher than those found in other ambulatory care studies 8. Fewer than one-third, however, had moderate to severe crusting, and only 1 in 10 had moderate to severe weeping, so it is possible that not all participants had actual infection.
Nevertheless, all patients had what clinicians believed to be infected eczema, so the evidence provided by this study is of direct relevance to current practice.
The mean age of children in our study was less than 3 years, and only a small number of participants were from ethnic minorities. Therefore, our results may not be generalizable to older children or those from ethnic minorities. The only previous study to assess the effect of an antibiotic in children with clinically infected eczema involved only 33 children and found no difference between those randomized to cefadroxil and those randomized to placebo.
Two small trials of oral antibiotics failed to demonstrate any beneficial effect in children and adults with clinically uninfected eczema, 28 , 29 and a trial of topical mupirocin plus hydrocortisone in 83 infants found no benefit over steroid alone in terms of the primary outcome but did report a significant lower EASI score in the combination group at day 8.
Our data provide strong evidence that not all children with clinically infected eczema need to be treated with antibiotics. We recruited only a small proportion of potentially eligible study subjects, however, and excluded patients with severe infection. The table of baseline characteristics suggests that our cohort tended to have relatively mild signs of infection, so our results may not be generalizable to all children with clinically infected eczema.
Topical and oral antibiotics in wound care.
On examining the child's ear you notice purulent discharge within the left ear canal and a grommet in-situ. You wonder whether oral or topical antibiotics may be. Oral antibiotics are the mainstay treatment for moderate to severe acne. However , oral therapy should be combined with topical therapy wherever possible to. If antibiotic treatment is required, prescribe an oral medicine; Topical antibiotics may be appropriate as a second-line option for patients with.