Topical antibiotics: Uses, common brands, and safety info

Topical antibiotics are antibiotic medications used to treat or prevent bacterial infections on the skin or mucous membranes. They are available both over-the-counter and with a prescription. Keep reading to learn more about the different types of topical antibiotics, what they are most commonly used for, and some common side effects associated with their use.

Other topical antibiotics:

• Xepi (ozenoxacin)

• Emcin Clear (erythromycin)

• Garamycin (gentamicin)

• Meclan (meclocycline)

• Neomycin

• Neomycin/polymyxin B

What are topical antibiotics?

Topical antibiotics are antibacterial medications that are specifically formulated for bacterial skin infections. Antibiotics fall under a larger category of products called antimicrobials, and they are related to compounds called antiseptics. However, it is important to note that topical antibiotics are NOT the same as antiseptics.

• Antimicrobials kill or slow the growth of bacteria and other pathogens, such as fungi, parasites, mites, and viruses.

• Antibiotics kill bacteria only.

• Antiseptics slow or deter the growth of bacteria. They are usually non-specific in how they work to kill a broad range of bacteria, and they include solutions like hydrogen peroxide and isopropyl alcohol. 

Topical antibiotics are available in different preparations depending on the areas of the body they will be used on and the conditions they will be used to treat. You will most commonly find them in the form of antibiotic ointments, emollient creams, lotions, cleansers, or foams. You may also find them in combination with anesthetic pain relievers or other antimicrobials to decrease pain or improve the medication’s effectiveness. 

RELATED: Antibiotics 101

How do topical antibiotics work?

The skin is the largest organ of the human body and serves several important functions. As a barrier, your skin prevents harmful bacteria from entering the inside of your body. When the skin has been damaged, as is the case with a cut or a burn, there is an increased risk of infection due to bacteria being able to invade the open wound. The surrounding area of skin damage can then become susceptible to a local infection. A skin infection left untreated can lead to complications as well as an increased risk of infection in the bloodstream, called sepsis.

Topical antibiotics are applied locally to the affected area where they can prevent growth and the spread of bacteria. 

Each class of topical antibiotics specifically kills bacteria by a different mechanism. A healthcare professional can help you determine which type of topical antibiotic is appropriate for your condition. 

What are topical antibiotics used for?

Topical antibiotics are widely used in the emergency and operating room, as well as at home. They are most commonly used in dermatology for:

• Minor cuts, scrapes, and burns

• More severe skin lesions and deep burns

• Small animal bites or puncture wounds

• Methicillin-resistant Staphylococcus aureus (MRSA) infection

• Injuries to the eye or eye infections in infants, children, and adults

• Pediatric skin conditions, such as impetigo

• Dermatologic conditions of the scalp

• Acne vulgaris

• Prevention of bacterial colonization in at-risk individuals

• Skin preparation before surgical procedures

Types of topical antibiotics

Like oral antibiotics, topical antibiotics are grouped by class, with each exhibiting a specific mechanism by which they exert bactericidal activity. 

Silver containing topical antibiotics 

Silver sulfadiazine has broad-spectrum bactericidal activity. It kills a range of different bacteria by damaging the bacterial cell membranes and cell walls. Since it can kill many kinds of bacteria that commonly grow on the skin, it is often used to treat large burns where the integrity of the skin is severely compromised, such as second- and third-degree burns. 

Inhibitors of bacterial folate metabolism 

Sodium sulfacetamide blocks the enzyme involved in bacterial folate metabolism to help stop the growth of bacteria. This medication is typically used in dermatology for facial and scalp conditions, like acne and dandruff, and it is often combined with sulfur for increased effectiveness. 

RNA synthetase inhibitors 

Bactroban (mupirocin) blocks an enzyme called isoleucyl transfer-RNA synthetase, which is needed for making bacterial RNA and proteins. This mechanism of action results in bacterial death. It is typically used for skin infections caused by S. aureus, S. pyogenes, or MRSA. 

Pleuromutilins 

Altabax (retapamulin) is in a new class of antimicrobials called pleuromutilins. Altabax blocks 50S ribosome activity and therefore the ability of bacteria to make proteins, resulting in bacterial death.

Combination antibiotics

Neosporin preparations containing two other antibiotics, like neomycin and polymyxin B, are also known as triple antibiotics since they contain three different classes of antibiotics. These antibiotics work synergistically to slow bacterial growth as well as kill a variety of bacteria that could colonize minor injuries on the skin. 

Polypeptide antibiotics 

Bacitracin is a polypeptide topical antibiotic that blocks the production of important proteins needed to create the bacterial cell wall. Without a functioning cell wall, the bacteria dies. 

Polymyxins are a class of antibiotics that bind to lipids and proteins on bacterial cell walls. This binding disrupts the cell wall and causes the bacteria to die. 

Macrolide antibiotics 

Erythromycin and other macrolide antibiotics bind to the 50S subunit of bacterial ribosomes. This prevents bacterial protein synthesis and bacterial growth. 

Aminoglycoside antibiotics 

Gentamicin inhibits bacterial protein synthesis by binding to the 30S subunit of bacterial ribosomes. This prevents bacterial protein synthesis and bacterial growth. 

Tetracycline antibiotics 

These antibiotics block bacterial protein synthesis by binding to the 30S subunit of bacterial ribosomes. This prevents bacterial protein synthesis and bacterial growth.

Sulfonamide antibiotics

Sulfamylon (mafenide) is a topical sulfonamide that stops the growth of a wide range of bacteria. The exact way in which it works is unknown; however, it has activity against certain bacteria such as Pseudomonas aeruginosa.

Who can take topical antibiotics?

Topical antibiotics are generally well-tolerated with a low risk of systemic side effects. 

Can men take topical antibiotics?

Yes, men can use both over-the-counter and prescription topical antibiotics. 

Can women take topical antibiotics?

Yes, women can use both over-the-counter and prescription topical antibiotics. 

Can women take topical antibiotics while pregnant or breastfeeding?

Topical antibiotics may have a lower risk of systemic side effects than oral antibiotics since they are not extensively absorbed through the skin. It is important to talk to your healthcare provider about the use of topical antibiotics while you are pregnant or breastfeeding as some antimicrobials may cause adverse effects in a fetus or newborn. Certain antibiotics have been shown to cause fetal harm when given systemically and may need to be avoided. These include:

• Aminoglycoside: linked to hearing loss in newborns 

• Tetracyclines: may cause liver damage in the mother, and they may cause discoloration of the teeth and altered bone growth in a fetus 

RELATED: Antibiotics during pregnancy 

Can children take topical antibiotics?

Yes, children and infants can use topical antibiotics safely at home, or as prescribed by their healthcare provider. 

Can seniors take topical antibiotics?

Yes, seniors can use topical antibiotics safely at home or as prescribed by their healthcare provider. 

Are topical antibiotics safe?

Topical antibiotics are generally considered safe. 

Restrictions 

Individuals with an allergy to a certain antibiotic should avoid using antibiotics that are part of the same antibiotic class as the one they are allergic to. Topical preparations of antibiotics and antibiotic-containing products should also be avoided in those with allergies to other components of the topical antibiotic preparation. If you have allergies to certain medications, speak with your healthcare provider about which topical antibiotics may be safe to use if you need a topical antibiotic to treat your specific medical condition. 

Common topical antibiotics side effects

The most common adverse effect associated with topical antibiotic use is contact dermatitis. Contact dermatitis is an allergic reaction characterized by local itching and irritation at the application site. The area may also be red, inflamed, and weepy. In these cases, it is best to discontinue use of the suspected topical antibiotic if it is an over-the-counter preparation or contact a healthcare provider if it is a prescription medication. There may be other preparations available to treat your specific condition. 

Topical antibiotics are systemically absorbed in some cases. While extremely rare, it is possible to have a severe allergic reaction to topical preparations containing antibiotics. 

Other signs and symptoms of an allergic reaction include:

• Edema or swelling in the area or other areas of the body

• Increased sweating 

• Fainting or dizziness 

• Difficulty breathing 

• Nausea or vomiting 

• Diarrhea 

• Chest tightness or discomfort 

If you experience any of these signs or symptoms, seek medical care right away. 

How much do topical antibiotics cost?

Topical antibiotics are generally affordable with variable prices depending on the formulation. Some over-the-counter ointments only cost a few dollars. Other prescription preparations such as sodium sulfacetamide/sulfur could be upwards of $80 per bottle or more. With SingleCare, you can pay approximately $25 for the same medication. If you have a prescription for a topical antibiotic check SingleCare to see if you can save money on your next fill.