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Alexandra Vaughn, MD

Alexandra Vaughn, MD

AUTHOR
Raja Sivamani, MD MS AP

Raja Sivamani, MD MS AP

EDITOR

Antibiotic Creams and Ointments - Whta's The Difference

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

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