Current and Emerging Topical Antibacterials and Antiseptics: Agents, Action, and Resistance Patterns

Abstract

Bacterial skin infections represent some of the most common infectious diseases globally. Prevention and treatment of skin infections can involve application of a topical antimicrobial, which may be an antibiotic (such as mupirocin or fusidic acid) or an antiseptic (such as chlorhexidine or alcohol). However, there is limited evidence to support the widespread prophylactic or therapeutic use of topical agents. Challenges involved in the use of topical antimicrobials include increasing rates of bacterial resistance, local hypersensitivity reactions (particularly to older agents, such as bacitracin), and concerns about the indiscriminate use of antiseptics potentially coselecting for antibiotic resistance. We review the evidence for the major clinical uses of topical antibiotics and antiseptics. In addition, we review the mechanisms of action of common topical agents and define the clinical and molecular epidemiology of antimicrobial resistance in these agents. Moreover, we review the potential use of newer and emerging agents, such as retapamulin and ebselen, and discuss the role of antiseptic agents in preventing bacterial skin infections. A comprehensive understanding of the clinical efficacy and drivers of resistance to topical agents will inform the optimal use of these agents to preserve their activity in the future.

Comparison of hydroalcoholic rubbing and conventional chlorhexidine scrubbing for aseptic skin preparation in dogs

“…10,12 To preserve the efficacy of antiseptic agents in controlling infections, it is essential to prevent the emergence of bacteria resistant to these compounds as well as cross resistance by using these antimicrobial compounds in an appropriate manner. 13,14 An emergence of resistance to CHX has been observed in clinical populations, which could translate into cross resistance to antibiotics. 15,16 Currently, there is no known resistance to hydroalcoholic (HA) solutions.…”

Skin cleansing and topical product use in patients with epidermolysis bullosa: Results from a multicenter database

“…Although frequency of topical product use was not surveyed, rotating of topical antibiotics every 2‐6 weeks is recommended by some authors to minimize the risk of antibiotic resistance . However, in several studies, higher rates of resistant bacteria have been correlated with more liberal use of topical antibiotics . Known risk factors for mupirocin‐resistant Staphylococcus aureus include prior mupirocin use and diagnosis of EB .…”

“…Topical antiseptics may have a role in place of topical antibiotics . Consensus guidelines suggest that silver, honey, and polyhexamethylene biguanide be used in cases of superficial critical colonization in EB .…”

“…6 However, in several studies, higher rates of resistant bacteria have been correlated with more liberal use of topical antibiotics. 5,[16][17][18] Known risk factors for mupirocin-resistant…”

“…19 Topical antiseptics may have a role in place of topical antibiotics. 18 Consensus guidelines suggest that silver, honey, and polyhexamethylene biguanide be used in cases of superficial critical colonization in EB. 6 However, silver-containing products and medical-grade honey use were reported by a minority of our cohort.…”