Resistant bacterial strains are on the rise. Therefore, topical antibiotics should be used to treat rather than prevent clinically manifested superinfections.
Prof. Domenico Bonamonte (Bari University, Italy) discussed the various indications for topical antibiotics, which are widely used in clinical practice . Besides for impetigo, topical antibiotics are also key components in the management of mild-to-moderate skin infections (see Figure). According to Prof. Bonamonte, an ideal topical antibiotic should penetrate the skin efficiently, reach adequate therapeutic doses, minimise cross-resistance, and have a weak sensitisation potential.
Figure: Conditions besides impetigo that may also require topical antibiotics 
Fusidic acid became a first-choice treatment option in primary and secondary skin infection due to its efficacy, safety, sensitisation potential, resistance profile, and spectrum selectivity. After topical application, it reaches high antimicrobial concentrations in deep skin layers. Fusidic acid has a high bactericidal activity against S. epidermidis, Streptococcus pyogenes, Propionibacterium acnes, Corynebacterium, Clostridia, and S. aureus, including methicillin-resistant strains . Fusidic acid can not only be used to treat superinfected atopic dermatitis but also for the management of non-infected atopic skin. Since S. aureus releases antigens that sustain the inflammatory reactions in atopic patients, fusidic acid may be applied in combination with corticosteroids in the management of patients with atopic dermatitis. However, studies have not demonstrated any benefits from antibiotic treatment in reducing atopic dermatitis flare-ups.
- Bonamonte D. Indications for topical antibiotics. D1T04.3C, EADV 2020 Virtual Congress, 29-31 Oct.
- Bonamonte D, et al. G Ital Dermatol Venereol 2014;149:453-9.
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