Bacterial skin infections
To reduce the development of resistance it is advisable to limit the choice of antibiotic used topically to one not used systemically. Whenever possible, swabs for bacterial examination should be taken before treatment is started.
It is generally advised that topical antimicrobials are not used. The exceptions to this are the use of metronidazole topically for acne rosacea, and in the management of malodorous wounds. Topical fusidic acid should be reserved for impetigo where there are very localised lesions only. In the presence of visible or proven infection, systemic antibiotics are to be used. See antimicrobial guidelines.
Silver sulfadiazine is used in the treatment of infected burns.
Mupirocin is only used to treat MRSA.
Mupirocin ointment contains macrogols and therefore caution is advised in renal impairment. The ointment may sting if used in open wounds unlike the cream which is suitable for use in such situations. The cream and ointment are not interchangeable and therefore prescriptions should specify formulation.
Used in acne roseacea and malodorous fungating tumours. Different brands are licensed for different indications. For malodorous tumours use Anabact® gel and for roseacea use Rosex® gel or cream