Demystify the Differences Between Antibiotic Creams and Ointments

Which antibiotic ointments are used for skin rashes?

Lemon with some leaves next to top view of skin cream on a wooden table

Credits: "xbqs42 at Pixabay.com"

Author:

Alexandra Vaughn, MD

Edited by:

Raja Sivamani, MD MS AP

What are Topical Antibiotics?

Topical antibiotics are medications used to inhibit or destroy the growth of bacteria. They usually come in the form of creams or ointments that are applied to the skin.

Below are topical antibiotics commonly used for the skin, including brand names:

Table 1. Topical Antibiotics Used in Dermatology

Topical Antibiotics	Brand Names
Bacitracin^[1]	Bacitracin
Neosporin® (Bacitracin/ Neomycin/ Polymyxin B)^[2]	Neosporin® Original, Triple Antibiotic
Clindamycin^[3]	Cleocin, Cleocin-T, Clindacin ETZ, Clindacin Pac, Clindacin-P, Clindagel, ClindaMax, Clindesse, Evoclin
Erythromycin^[4]	Akne-Mycin, Ery, Erygel
Mafenide^[5]	Sulfamylon
Mupirocin^[7]	Bactroban, Bactroban Nasal, Centany
Retapamulin^[6]	Altabax
Silver sulfadiazine^[8]	Silvadene, SSD, Thermazene
Sulfacetamide sodium/ sulfur^[9]	APOP, Klaron, Ovace Wash, Seb-Prev Wash

How Do Topical Antibiotics Work?^[10]

Bacitracin – inhibits cell wall formation by bacteria
Neosporin®(Bacitracin/Neomycin/Polymyxin B) – interferes with bacterial protein synthesis and cell wall formation
Clindamycin – inhibits bacterial protein synthesis
Erythromycin – inhibits bacterial protein synthesis
Mafenide – interferes with bacterial folic acid synthesis
Mupirocin – inhibits bacterial protein synthesis
Retapamulin – inhibits bacterial protein synthesis
Silver sulfadiazine – acts against bacterial cell wall and cell membrane
Sulfacetamide – inhibits bacteria’s ability to make folic acid

What Conditions Do Topical Antibiotics Treat?^[10]

Table 2. FDA-Approved Uses of Antibiotic Medications

Topical Antibiotic	Skin Conditions	Other Conditions
Bacitracin	Secondary bacterial skin infections
Neosporin® (Bacitracin/ Neomycin/ Polymyxin B)	Prevention and treatment of skin infection in mild cuts
Clindamycin	Acne	Bacterial vaginosis
Erythromycin	Acne
Mafenide	Mafenide cream for treatment of patients with second and third-degree burns, or used on moist dressings over skin grafts for burns
Mupirocin	-Eradication of nasal colonization with MRSA -Impetigo -Secondary bacterial skin infections
Retapamulin	Impetigo
Sulfacetamide lotion	-Acne -Dandruff -Seborrheic dermatitis -Secondary bacterial skin infection
Silver sulfadiazine	Prevention of wound sepsis in second and third-degree burns

How Are Topical Antibiotics Given?

Topical antibiotic medications are typically given as a cream or ointment that is applied to the skin. Topical antibiotics are often used daily for one to two weeks but sometimes require repeat treatments. Certain topical antibiotics are also given in the form of shampoo and body wash to treat conditions such as dandruff.

Common Side Effects and Risks of Topical Antibiotics

Table 3. Most Common Side Effects of Topical Antibiotics

Topical Antibiotics	Side Effects
Bacitracin	Skin redness, burning, anaphylaxis (rare)
Neosporin® (Bacitracin/ Neomycin/ Polymyxin B)	Skin redness, allergic contact dermatitis, itching, slow healing, anaphylaxis
Clindamycin	Xeroderma, oily skin, erythema, skin burning, peeling, itching
Erythromycin	Skin peeling, redness, itching, fissuring around the mouth, skin tenderness, dryness, and burning at site of application
Mafenide	Facial edema, skin rash, and redness, hyperchloremia, diarrhea, bone marrow suppression, blisters and pain, hyperventilation, tachypnea, hypersensitivity
Mupirocin	Headache, skin burning, itching, rash, nausea, rhinitis, congestion, hypersensitivity
Retapamulin	Headache, atopic dermatitis, diarrhea, skin irritation, itching
Silver sulfadiazine	Erythema multiforme, pruritus, skin photosensitivity, discoloration, rash, agranulocytosis, aplastic anemia, hypersensitivity reaction, interstitial nephritis
Sulfacetamide	Skin burning, stinging, Stevens-Johnson syndrome, hypersensitivity reaction, fulminant hepatic necrosis; contraindicated in people with known “sulfa” allergy

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References

FDA. Bacitracin Ointment. Link to research.
FDA. TRIPLE ANTIBIOTIC. Link to research.
FDA. Clindagel. Link to research.
FDA. ERYTHROMYCIN; Link to research.
FDA. Sulfamylon. Link to research.
FDA. Altabax. Link to research.
FDA. Bactroban Ointment; Link to research.
FDA. Silvadene; Link to research.
Link to research.
Drucker CR. Update on topical antibiotics in dermatology. Dermatol Ther.2012;25(1):6-11; PMID: 22591495.