When are topical antibiotics appropriate for skin infections? What are the benefits and drawbacks of using topical antibiotics for skin conditions like atopic dermatitis? Get the facts.

Understanding Topical Antibiotics for Skin Infections

Topical antibiotics are a common treatment option for various skin infections, including those associated with conditions like atopic dermatitis. These medications are applied directly to the affected area of the skin, aiming to target and eliminate the underlying bacterial infection. The use of topical antibiotics can be an effective way to manage skin infections, but it’s important to understand when they are appropriate and the potential benefits and drawbacks of this approach.

The Role of Staphylococcus Aureus in Atopic Dermatitis

Atopic dermatitis, also known as eczema, is a chronic inflammatory skin condition that often involves a complex interplay between genetic, environmental, and immunological factors. One key aspect of atopic dermatitis is the increased susceptibility to skin colonization by the bacterium Staphylococcus aureus (S. aureus). Studies have shown that up to 90% of individuals with atopic dermatitis have S. aureus present on their skin, contributing to the development and exacerbation of the condition.

The adherence of S. aureus to corneocytes (the outer layer of skin cells) and the production of various virulence factors by the bacteria can lead to skin irritation, inflammation, and increased susceptibility to secondary infections. This close association between S. aureus and atopic dermatitis has led to the consideration of anti-staphylococcal treatments as a potential approach to managing the condition.

Benefits of Topical Antibiotics in Atopic Dermatitis

The use of topical antibiotics in the management of atopic dermatitis can offer several potential benefits:

1. Reduced Skin Colonization: Topical antibiotics can help reduce the overall burden of S. aureus on the skin, potentially leading to a decrease in inflammation and improved symptom control.
2. Improved Barrier Function: By addressing the bacterial component of atopic dermatitis, topical antibiotics may help restore the skin’s barrier function and reduce susceptibility to further infections.
3. Reduced Flare-ups: Some studies have suggested that the use of topical antibiotics in combination with other treatments, such as topical corticosteroids, may help reduce the frequency and severity of atopic dermatitis flare-ups.

Potential Drawbacks of Topical Antibiotics

While topical antibiotics can be beneficial in certain cases, there are also some potential drawbacks to consider:

1. Antibiotic Resistance: Prolonged or inappropriate use of topical antibiotics can contribute to the development of antibiotic-resistant strains of bacteria, which can make future infections more challenging to treat.
2. Skin Irritation: Some individuals may experience skin irritation or allergic reactions to the topical antibiotics, which can exacerbate the existing skin condition.
3. Limited Effectiveness: In some cases, topical antibiotics may not be sufficient to control the bacterial component of atopic dermatitis, and a more comprehensive treatment approach may be necessary.

Considerations for Using Topical Antibiotics

When considering the use of topical antibiotics for skin infections, it’s important to work closely with a healthcare professional to determine the appropriate treatment plan. Factors to consider include the severity of the infection, the presence of any complicating factors (such as immunocompromised status or underlying conditions), and the potential risk of antibiotic resistance. In many cases, a combination of topical antibiotics and other treatments, such as topical corticosteroids or moisturizers, may be the most effective approach.

Emerging Alternatives to Topical Antibiotics

As concerns about antibiotic resistance grow, researchers are exploring alternative approaches to managing bacterial skin infections. Some of these emerging alternatives include the use of antimicrobial peptides, probiotic-based treatments, and the development of novel antimicrobial agents that are less likely to contribute to resistance. While these alternatives are still being studied, they may offer promising new options for the management of skin infections in the future.

Conclusion

Topical antibiotics can be a valuable tool in the management of certain skin infections, particularly those associated with conditions like atopic dermatitis. However, it’s crucial to carefully consider the potential benefits and drawbacks of this approach and work closely with healthcare professionals to develop an appropriate treatment plan. By understanding the role of topical antibiotics and exploring emerging alternatives, individuals with skin infections can work towards better management and improved outcomes.

Anti-staphylococcal treatment in dermatitis – PMC

1. Hanifin JM. Diagnostic features of atopic dermatitis. Acta Derm Venereol. 1980;92(Suppl):44–7. [Google Scholar]

2. Levy RM, Gelfand JM, Yan AC. The epidemiology of atopic dermatitis. Clin Dermatol. 2003;21(2):109–15. [PubMed] [Google Scholar]

3. Hauser C, Wuethrich B, Matter L, Wilhelm JA, Sonnabend W, Schopfer K. Staphylococcus aureus skin colonization in atopic dermatitis. Dermatologica. 1985;170(1):35–9. [PubMed] [Google Scholar]

4. Cole GW, Silverberg NL. The adherence of Staphylococcus aureus to human corneocytes. Arch Dermatol. 1986;122(2):166–9. [PubMed] [Google Scholar]

5. Ong PY, Ohtake T, Brandt C, Strickland I, Boguniewicz M, Ganz T, et al. Endogenous antimicrobial peptides and skin infections in atopic dermatitis. N Engl J Med. 2002;347(15):1151–60. [PubMed] [Google Scholar]

6. William RE, Gibson AG, Aitchison TC, Lever R, Mackie RM. Assessment of a contact-plate sampling technique and subsequent quantitative bacterial studies in atopic dermatitis. Br J Dermatol. 1990;123(4):493–501. [PubMed] [Google Scholar]

7. Guzik TJ, Bzowska M, Kasprowicz A, Czerniawska-Mysik G, Wójcik K, Szmyd D, et al. Persistent skin colonization with Staphylococcus aureus in atopic dermatitis: relationship to clinical and immunological parameters. Clin Exp Allergy. 2005;35(4):448–55. [PubMed] [Google Scholar]

8. Zollner TM, Wichelhaus TA, Hartung A, Von Mallinckrodt C, Wagner TO, Brade V, et al. Colonization with superantigen-producing Staphylococcus aureus is associated with increased severity of atopic dermatitis. Clin Exp Allergy. 2000;30(7):994–1000. [PubMed] [Google Scholar]

9. Gilani SJ, Gonzalez M, Hussain I, Finlay AY, Patel GK. Staphylococcus aureus re-colonization in atopic dermatitis: beyond the skin. Clin Exp Dermatol. 2005;30(1):10–3. [PubMed] [Google Scholar]

10. Ewing CI, Ashcroft C, Gibbs AC, Jones GA, Connor PJ, David TJ. Flucloxacillin in the treatment of atopic dermatitis. Br J Dermatol. 1998;138(6):1022–9. [PubMed] [Google Scholar]

11. Weinberg E, Fourie B, Allmann B, Toerien A. The use of cefadroxil in super-infected atopic dermatitis. Curr Ther Res. 1992;52(5):671–6. [Google Scholar]

12. Brockow K, Grabenhorst P, Abeck D, Traupe B, Ring J, Hoppe U, et al. Effect of gentian violet, corticosteroid and tar preparations in Staphylococcus-aureus-colonized atopic eczema. Dermatology. 1999;199(3):231–6. [PubMed] [Google Scholar]

13. Parish LC, Jorizzo JL, Breton JJ, Hirman JW, Scangarella NE, Shawar RM, et al. Topical retapamulin ointment (1%, wt/wt) twice daily for 5 days versus oral cephalexin twice daily for 10 days in the treatment of secondarily infected dermatitis: results of a randomized controlled trial. J Am Acad Dermatol. 2006;55(6):1003–13. Epub 2006 Oct 6. [PubMed] [Google Scholar]

14. Lever R, Hadley K, Downey D, Mackie R. Staphylococcal colonization in atopic dermatitis and the effect of topical mupirocin therapy. Br J Dermatol. 1988;119(2):189–98. [PubMed] [Google Scholar]

15. Bath-Hextall FJ, Birnie AJ, Ravenscroft JC, Williams HC. Interventions to reduce Staphylococcus aureus in the management of atopic eczema: an updated Cochrane review. Br J Dermatol. 2010;163(1):12–26. Epub 2010 Mar 5. [PubMed] [Google Scholar]

16. Plötz SG, Ring J. What’s new in atopic eczema? Expert Opin Emerg Drugs. 2010;15(2):249–67. [PubMed] [Google Scholar]

17. Gong JQ, Lin L, Lin T, Hao F, Zeng FQ, Bi ZG, et al. Skin colonization by Staphylococcus aureus in patients with eczema and atopic dermatitis and relevant combined topical therapy: a double-blind multicentre randomized controlled trial. Br J Dermatol. 2006;155(4):680–7. [PubMed] [Google Scholar]

18. Hung SH, Lin YT, Chu CY, Lee CC, Liang TC, Yang YH, et al. Staphylococcus colonization in atopic dermatitis treated with fluticasone or tacrolimus with or without antibiotics. Ann Allergy Asthma Immunol. 2007;98(1):51–6. [PubMed] [Google Scholar]

19. Schuttelaar ML, Coenraads PJ. A randomized, double-blind study to assess the efficacy of addition of tetracycline to triamcinolone acetonide in the treatment of moderate to severe atopic dermatitis. J Eur Acad Dermatol Venereol. 2008;22(9):1076–82. Epub 2008 Apr 1. [PubMed] [Google Scholar]

20. Stinco G, Piccirillo F, Valent F. A randomized double-blind study to investigate the clinical efficacy of adding a non-migrating antimicrobial to a special silk fabric in the treatment of atopic dermatitis. Dermatology. 2008;217(3):191–5. Epub 2008 Jun 27. [PubMed] [Google Scholar]

21. Koller DY, Halmerbauer G, Böck A, Engstler G. Action of a silk fabric treated with AEGIS in children with atopic dermatitis: a 3-month trial. Pediatr Allergy Immunol. 2007;18(4):335–8. Epub 2007 Mar 7. [PubMed] [Google Scholar]

Topical antibiotics for skin infections: when are they appropriate?

This item is 6 years and 3 months old; some content may no longer be current.

Antibiotic resistance and stewardshipDermatologyInfections

In the community, many patients have skin and soft tissue infections that are relatively minor, e.g. scrapes and scratches or mild folliculitis. These types of infections do not usually require antibiotic treatment as they will generally improve with good skin hygiene measures, e.g. cleaning and covering the lesion. A prescription for a topical antiseptic (rather than a topical antibiotic) is a pragmatic next step if hygiene interventions are not sufficient.

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What prescribers need to know:

• In primary care, many skin infections are relatively minor and do not need to be treated with antibiotics. Management
  should focus on good skin hygiene measures and a trial of a topical antiseptic
• Do not prescribe topical antibiotics for patients with infected eczema, for wound management, for other skin infections,
  or first-line for impetigo. If antibiotic treatment is required, prescribe an oral medicine
• Topical antibiotics may be appropriate as a second-line option for patients with areas of localised impetigo, if first-line
  management with hygiene measures and topical antiseptics has not resolved the lesions or for Staphylococcus aureus nasal
  decolonisation
• If a topical antibiotic is prescribed, patients should be instructed to use it for no longer than seven days. The
  practice of saving an unfinished tube as a “first-aid” measure for household members should be strongly discouraged

For further information on the changing role of topical antibiotics in New Zealand, see: “Topical antibiotics
for skin infections – should they be prescribed at all?”

Few clinical situations require topical antibiotics

In the community, many patients have skin and soft tissue infections that are relatively minor, e. g. scrapes and scratches
or mild folliculitis. These types of infections do not usually require antibiotic treatment as they will generally improve
with good skin hygiene measures, e.g. cleaning and covering the lesion.¹ A prescription for a topical antiseptic
(rather than a topical antibiotic) is a pragmatic next step if hygiene interventions are not sufficient, although guidance
on the use of antiseptics varies and there is a relative lack of evidence for their effectiveness.^2–4

If a patient has an infection that requires antibiotic treatment, e.g. they have extensive infection, systemic symptoms
or co-morbidities that place them at higher risk of infection or poor healing, in most cases prescribe an oral not a topical
antibiotic.

Due to increasing resistance, infectious diseases experts recommend that topical antibiotics should have a very limited
role in clinical practice.^{2, 5} Currently the two clinical situations where their use may still be appropriate
are:

• As a second-line option for patients with areas of localised impetigo (e. g. less than three lesions) if first-line
  management with hygiene measures and topical antiseptics has not resolved the lesions within an appropriate timeframe,
  e.g. five to seven days. If a topical antibiotic is prescribed, fusidic acid should be used; mupirocin is reserved for
  treating MRSA infection. In many cases of impetigo, treatment with an oral antibiotic is more appropriate
• Some patients with recurrent skin infections due to Staphylococcus aureus may require nasal decolonisation with either
  fusidic acid or mupirocin once susceptibility is known. If the isolate is resistant to both topical antibiotics
  or there is active infection, oral antibiotics may be required (see below)

See “Topical antibiotics and antiseptics available in New Zealand” for information on available medicines

If topical antibiotics are prescribed, instruct the patient to use the medicine for up to seven days only and to discard
the tube after this time. The practice of saving an unfinished tube as a “go-to” first-aid measure for household members
should be strongly discouraged.⁵

Topical antibiotics and antiseptics available in New Zealand

Two topical antibiotics and two topical antiseptics for use on the skin are currently subsidised in New Zealand.^*

The topical antibiotics are:⁶

• Fusidic acid (sodium fusidate) cream or ointment 2% – 15 g tube, fully subsidised
• Mupirocin ointment 2% – 15 g tube, partially subsidised

The topical antiseptics are:⁶

• Hydrogen peroxide cream 1% – 15 g tube, fully subsidised (also available over-the-counter in a 10 g or 25 g tube)
• Povidone-iodine ointment 10% – 25 g tube, fully subsidised (also available over-the-counter in a range of tube
  sizes)

* Other topical antibiotics are available, e.g. for acne and for infections of the eye and nose, including fusidic acid
as an eye gel (Fucithalmic). Compound preparations, e.g. fusidic acid + betamethasone valerate (Fucicort, partly subsidised)
and hydrocortisone + natamycin + neomycin (Pimafucort, fully subsidised) are also available. The use of these medicines
is not covered in this resource, however, similar restraints with prescribing should also apply to these medicines.

For a snapshot of national and individual prescribing data for these topical medicines, see: “Prescribing
of topical medicines for skin infections”

Limit the use of fusidic acid in the management of impetigo

Impetigo is regarded as a self-limiting condition although treatment is often initiated to hasten recovery and to reduce
the spread of infection.⁷ There is, however, a lack of quality evidence-based research on the optimal management
of impetigo.² Recent expert opinion is that first-line management in the majority of children with mild to
moderate impetigo is good skin hygiene and topical antiseptic preparations.

For further information on current views on the role of topical antibiotics, see:
www.goodfellowunit.org/podcast/topical-antibiotics-emma-best

Skin hygiene measures in children with impetigo should start with the “clean, cut (nails) and cover” message, which
also applies to patients with other skin infections or injuries.² Advise parents or caregivers to use a
clean cloth soaked in warm water to gently remove crusts from lesions. Infectious diseases experts
then recommend the application of a topical antiseptic such as hydrogen peroxide or povidone-iodine.
These antiseptic preparations can also assist in softening the crusted areas. Parents and caregivers
should be advised to keep the affected areas covered with dressings to reduce the spread of infection
to others. The child should be excluded from school or pre-school until the lesions have dried up or for 24 hours after
oral antibiotic treatment has been initiated. ⁸ If
required, assess and treat other household members who may be infected.

Oral antibiotics are recommended if:

• Lesions are extensive or there is widespread
  infection
• Systemic symptoms are present
• Good hygiene and topical antiseptic treatment has failed

The first choice for an oral antibiotic should be flucloxacillin. An appropriate dose for a child is:

• Flucloxacillin: 12.5 mg/kg/dose, four times daily, for five days (maximum 500 mg/dose)

Alternative oral antibiotics if there is allergy or intolerance to flucloxacillin include erythromycin, co-trimoxazole
(first choice if MRSA is present) and cefalexin.

Topical fusidic acid should only be considered as a second-line option for areas of very localised impetigo (e.g.
less than three lesions) if inital measures have been unsuccessful.

Decolonisation for patients with recurrent skin infections

Patients with recurrent skin infections and their family members may require decolonisation to reduce S.
aureus carriage.
The initial focus should be on good personal hygiene and environmental decolonisation.⁹ If this approach
has been unsuccessful and the patient continues to have recurrent skin infections, antibiotics may be required.

Advise intensification of personal hygiene measures

Patients should be advised to intensify personal hygiene practices and not to share items such as razors, towels
or linen. The regular use of antibacterial soaps or washes and weekly dilute bleach baths is often
advocated, although the evidence base for this is variable.^8–11 One approach is to prescribe triclosan
1% as a liquid soap to reduce the bacterial load on the skin. This can be used daily for five to
seven days then reduced to once or twice weekly. Triclosan 1% is fully subsidised in a
500 mL bottle, provided the patient has recurrent S. aureus infection and the prescription is endorsed accordingly.

Environmental decolonisation is recommended

Environmental measures should include cleaning of regularly touched surfaces and frequent washing of clothes, towels
and linen.⁹ The use of heat, e.g. hot water, hot dryer cycle or ironing, when laundering towels and linen
is often recommended. There is some evidence to support this practice and/or the use of an activated oxygen bleach product.¹³

Antibiotics are indicated if skin infections are recurrent despite other measures

If the patient continues to have recurrent skin infections despite optimal care and hygiene measures, personal decolonisation
with antibiotics may be required and also considered for family members.⁹ A nasal swab to determine whether
the patient has S. aureus nasal colonisation should be requested, if this has not already been done. Consider
discussing an appropriate decolonisation regimen with an infectious diseases expert as advice is likely to vary due
to local resistance patterns. There is a lack of consensus on the most effective decolonisation method and increasing
antibiotic resistance continues to drive research into alternative options both in New Zealand and internationally.
For example, the antiseptic povidone-iodine used intranasally has been suggested as an alternative to a topical antibiotic,
but consistent evidence for its effectiveness is lacking.^{12, 14}

Topical antibiotic treatment – if topical antibiotics are recommended, the appropriate topical antibacterial (either
mupirocin or fusidic acid as guided by the sensitivity results) should be applied to the anterior nares, twice daily, for five
to seven days. They should not be administered if the patient still has an active skin infection as the skin infection can be
a source from which nasal carriage is re-established. Good personal hygiene measures and environmental decolonisation measures should be ongoing.

Oral antibiotic treatment – although international guidelines do not recommend the routine use of
oral antibiotics for decolonisation there may be a role for this strategy when first-line measures have been unsuccessful
or when there is active infection.¹⁵ Prescribing a combination of oral antibiotics (usually two) has been
found to be effective for decolonisation, however, they may need to be used concurrently with topical antibiotics to
achieve eradication of S. aureus from the nose.^{12, 15} The choice of oral antibiotics should usually
be made after a discussion with an infectious diseases physician or clinical microbiologist and in addition should
be guided by the sensitivity results from nasal swabs. A typical oral regimen for an adult with recurrent skin infections
would include both rifampicin* (e.g. 300 mg, twice daily) and flucloxacillin (e.g. 500 mg, three or four times daily). ^**12,
15 Both oral antibiotics are taken for one week and then repeated for one week each month for three to six months.

* Rifampicin requires specialist approval for prescription. This can be
obtained from an infectious disease specialist or a clinical microbiologist
at a community laboratory and the prescription endorsed accordingly

** Alternative antibiotics to flucloxacillin include co-trimoxazole or doxycycline (used in combination with rifampicin)

Many patients with mild bacterial skin infections do not require antibiotics

Folliculitis is often self-limiting

Folliculitis is a collective term for a group of skin conditions which can be due to bacterial infection but can be
also caused by fungi and viruses. A sterile folliculitis can be the result of occlusion, e.g. from the use of emollients
(particularly paraffin-based ointments), or adhesive dressings.¹⁶ In addition, environmental factors, e. g.
hot, humid weather, shaving and other forms of hair removal, medicines such as topical or oral corticosteroids and immunosuppression
may all contribute to folliculitis.^{16, 17}

Superficial folliculitis is a mild, self-limiting condition and patients usually do not require topical or oral antibiotic
treatment. Management should focus on effective skin hygiene, avoiding or treating any underlying cause and topical antiseptics.¹⁷ If
the skin lesions are spreading, persistent or recurrent, oral antibiotics, such as flucloxacillin may need to be considered.

Furuncles (boils) and carbuncles are treated with incision and drainage

Larger lesions such as furuncles and carbuncles that extend into the subcutaneous tissue and are fluctuant should be
managed with incision and drainage alone. Patients do not usually need antibiotic treatment unless there is associated
cellulitis or the patient becomes systemically unwell. ¹⁸ An oral antibiotic, e.g. flucloxacillin, would be
appropriate in these situations.

Take a pragmatic approach to the management of skin infections

Although management for skin infections in primary care cannot be directed by a conclusive evidence base, the consensus
from infectious diseases experts is that, given the rise in antibacterial resistance rates in New Zealand, topical antiseptics
and education about good skin hygiene practices presents a pragmatic approach when managing patients with skin infections.
Inappropriate use of topical antibiotics has been clearly shown to be associated with rapidly rising resistance. Clinicians
need to be mindful of this and alter their management accordingly.

Acknowledgement

Thank you to Associate Professor Mark Thomas, Infectious Diseases Specialist, University of Auckland and Auckland City Hospital for expert review of this article.

References

1. Tsai J-YC, Anderson P, Broome L, et al. Antimicrobial stewardship using pharmacy data for the nurse-led school-based
   clinics in Counties Manukau District Health Board for management of group A streptococcal pharyngitis and skin infection. NZMJ 2016;129:29–38.
2. Vogel A, Lennon D, Best E, et al. Where to from here? The treatment of impetigo in children as resistance to fusidic
   acid emerges. NZMJ 2016;129:77–83.
3. Cooke J. When antibiotics can be avoided in skin inflammation and bacterial colonization: a review of topical treatments. Curr Opin Infect Dis 2014;27:125–9.
4. Leitch C, Leitch A, Tidman M. Quantitative evaluation of dermatological antiseptics. Clin Exp Dermatol 2015;40:912–5.
5. Williamson D, Ritchie S, Best E, et al. A bug in the ointment: topical antimicrobial usage and resistance in New
   Zealand. NZMJ 2015;128:103–9.
6. New Zealand Formulary (NZF). NZF v56. 2017. Available from: www.nzf.org.nz (Accessed Feb, 2017).
7. Yeoh D, Bowen A, Carapetis J. Impetigo and scabies – disease burden and modern treatment strategies. J Infection 2016;72:S61-7.
8. Impetigo (school sores). Ministry of Health. 2017. Available from:
   
   http://www.health.govt.nz/your-health/conditions-and-treatments/diseases-and-illnesses/impetigo-school-sores (Accessed Feb, 2017).
9. Creech C, Al-Zubeidi D, Fritz S. Prevention of recurrent staphylococcal skin infections. Infect Dis Clin N Am 2015;29:429–64.
10. Fritz S, Camins B, Eisenstein K, et al. Effectiveness of measures to eradicate Staphylococcus aureus carriage in
    patients with comunity-associated skin and soft tissue infections: a randomized trial. Infect Control Hosp Epidemiol
    2011;32:872–80.
11. Kaplan S, Forbes A, Hammerman W, et al. Randomised trial of ‘bleach baths’ plus routine hygienic measures vs routine
    hygienic measures alone for prevention of recurrent infections. Clin Infect Dis 2014;58:679–82.
12. Septimus E, Schweizer M. Decolonization in prevention of health care-associated infections. Clin Microbiol Rev 2016;29:201–22.
13. Bockmuhl D. Laundry hygiene – how to get more than clean. J Appl Microbiol 2017;epub ahead of print.
    http://dx.doi.org/10.1111/jam.13402
14. Anderson M, David M, Scholz M, et al. Efficacy of skin and nasal providone-iodine preparation against mupirocin-resistant
    methicillin-resistant Staphylococcus aureus and S. aureus within the anterior nares. Antimicrob Agents Chemother 2015;59:2765–73.
15. Liu C, Bayer A, Cosgrove S, et al. Clinical practice guidelines by the Infectious Disease Society of America for
    the treatment of methicillin resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis;52:e18-55.
16. Oakley A. Folliculitis. DermNet NZ. Available from:
    http://www. dermnetnz.org/topics/folliculitis/ (Accessed Feb, 2017).
17. Cunliffe T. Folliculitis and boils (furuncles/carbuncles). Primary Care Dermatology Society.
    http://www.pcds.org.uk/clinical-guidance/folliculitis-an-overview
18. Ibler K, Kromann C. Recurrent furunculosis – challenges and managment: a review. Clin Cosmet Investig Dermatol;7:59–64.

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How to effectively treat Staphylococcus aureus: tips and tricks

Learn how to effectively treat Staphylococcus aureus. Learn about various treatments, including antibiotics and topical treatments, and measures to prevent its spread.

Staphylococcus aureus, or Staphylococcus aureus, is one of the most common and dangerous pathogens. It can cause various infections, including skin, respiratory, and even septic. Staphylococcus aureus is highly resistant to antibiotics, which makes its treatment complex and requires an integrated approach.

Correct diagnosis is one of the keys to effective treatment of Staphylococcus aureus. To do this, it is necessary to analyze the microbiological material obtained from the patient. Identification of Staphylococcus aureus and its sensitivity to antibiotics will help you choose the best drug for treatment.

One of the main treatments for Staphylococcus aureus is antibiotic therapy. However, due to the high resistance of the bacterium to many antibiotics, the combined administration of several drugs may be required. It is also important to follow the rules for taking antibiotics and not skip doses to avoid the development of drug resistance.

In addition to antibiotics, in the treatment of Staphylococcus aureus, therapy with immunomodulators can be used, which is aimed at strengthening the immune system and increasing its protective functions. It is also important to practice good personal hygiene, wash your hands regularly, and treat wounds and cuts to prevent infection with Staphylococcus aureus.

What is Staphylococcus aureus?

Staphylococcus aureus (Staphylococcus aureus) is a Gram-positive bacterium that can cause various infections in humans. It got its name because of its ability to form golden colonies on nutrient media.

Staphylococcus aureus is one of the most common causative agents of bacterial infections such as pyoderma (purulent skin infection), pneumonia, sepsis and urinary tract infections.

One of the features of Staphylococcus aureus is its ability to develop resistance to antibiotics. This makes the treatment of infections caused by this bacterium difficult and requires the use of strong drugs.

For the diagnosis of Staphylococcus aureus, it is necessary to conduct a bacteriological study, during which the presence and sensitivity of the bacterium to antibiotics is determined.

Staphylococcus aureus is usually treated with antibiotics, but in some cases, surgery may be required to remove the purulent infection.

Symptoms of Staphylococcus aureus

Staphylococcus aureus is a bacterium that can cause various infections in humans. Before starting treatment, it is important to be able to recognize the symptoms of this disease.

One of the most characteristic symptoms of Staphylococcus aureus is the formation of blisters on the skin filled with a yellowish liquid. These blisters can be very itchy and uncomfortable.

Another symptom of Staphylococcus aureus is the appearance of red, inflamed areas on the skin. These areas can be painful and are often accompanied by swelling.

If the infection spreads deeper, other symptoms may appear, such as fever, chills, headache, and muscle weakness.

In case of involvement of other organs, the symptoms may vary depending on the particular organ. For example, a lung infection can cause symptoms that are characteristic of pneumonia, such as coughing, difficulty breathing, and chest pain.

If you notice these symptoms, it is important to see a doctor for an accurate diagnosis and appropriate treatment.

How to diagnose Staphylococcus aureus?

Diagnosis of Staphylococcus aureus is an important step in determining the cause of the disease and prescribing effective treatment. Various methods are used for diagnosis, including clinical examination, laboratory and microbiological studies.

The doctor makes a visual examination of the affected area of ​​the skin or mucous membranes, looking for characteristic symptoms such as redness, swelling, blistering or sores. However, clinical symptoms may be intermittent and not always pronounced, so laboratory testing is necessary.

For laboratory diagnosis of Staphylococcus aureus, culture methods are used. The doctor takes a swab or biopsy of the affected tissue and places it on a nutrient medium that promotes the growth of bacteria. Then, experts carry out the identification and antibiotic sensitivity of the isolated strain of Staphylococcus aureus.

Microbiological examination allows to determine the presence and concentration of bacteria, as well as to determine their sensitivity to antibiotics. This allows you to choose the most effective treatment and prevent the development of antibiotic resistance.

Treatment of Staphylococcus aureus: basic principles

Staphylococcus aureus is one of the most common infectious agents in humans. If it is found in the body, treatment should be started immediately. The main principles of the treatment of Staphylococcus aureus are:

1. Antibiotic therapy: Antibiotics must be used to kill bacteria. The choice of drug depends on the sensitivity of the pathogen to antibiotics. It is important to follow your doctor’s advice and take antibiotics as prescribed.
2. Hygiene: Regular handwashing with soap and water is one of the main measures to prevent the spread of Staphylococcus aureus. It is also necessary to regularly change and wash linen, towels and bed linen.
3. Isolation: If Staphylococcus aureus is found in the body, it is necessary to isolate the patient from others to prevent transmission of the infection. It is important to observe the rules of personal hygiene and use individual hygiene items.
4. Immunity booster: Strong immunity helps fight infection more effectively. To strengthen the immune system, proper nutrition, regular exercise, giving up bad habits and taking vitamin complexes are recommended.

Treatment of Staphylococcus aureus requires an integrated approach and supervision of a physician. It is important to follow all recommendations and not stop treatment ahead of schedule, even if the condition improves. This is the only way to completely get rid of the infection and prevent its recurrence.

Antibiotics for Staphylococcus aureus

Staphylococcus aureus is a bacterium that can cause various infections in humans, including skin infections, pneumonia, urinary tract infections, and sepsis. Treatment for Staphylococcus aureus usually involves the use of antibiotics, which can kill the bacterium or stop it from growing.

The choice of antibiotic for the treatment of Staphylococcus aureus depends on the type of infection, its severity, and the sensitivity of the bacteria to specific drugs. The standard antibiotic for treating Staphylococcus aureus is methicillin, but many strains of Staphylococcus aureus have become resistant to this drug. In such cases, other antibiotics such as vancomycin or linezolid may be prescribed.

Vancomycin is an antibiotic that is effective against most strains of Staphylococcus aureus. It is usually used when methicillin is not effective or cannot be used for other reasons. Vancomycin can be taken intravenously or by injection.

Linezolid is another antibiotic that can be used to treat Staphylococcus aureus. It is usually used for mild or moderate infections. Linezolid is available as tablets or intravenous forms.

It is important to remember that antibiotics should only be prescribed by a doctor and taken in accordance with his recommendations. The independent use of antibiotics without consulting a doctor can lead to the development of bacterial resistance and complicate the treatment of the infection.

Prevention of Staphylococcus aureus

Prevention of Staphylococcus aureus plays an important role in preventing its spread. To do this, you must follow a number of measures and recommendations that will help minimize the risk of infection.

The first thing to remember is personal hygiene. Washing your hands regularly with soap and water is one of the main ways to prevent Staphylococcus aureus infection. Particular attention should be paid to washing hands after visiting public places, before eating, after contact with animals and other situations where infection is possible.

It is also important to take care of the condition of the skin. Integrity of the skin is the first line of defense against Staphylococcus aureus. It is necessary to avoid injuries and damage to the skin, and in case of cuts or abrasions, treat them with an antiseptic.

In addition, it is recommended to avoid close contact with people suffering from Staphylococcus aureus. This is especially important for people with weakened immune systems, as they are more susceptible to infections.

Proper use of antibiotics is important in prevention. They should not be used without a doctor’s prescription and the need. Misuse of antibiotics can lead to the development of drug resistance in Staphylococcus aureus.

Community prevention measures, such as regular surface disinfection, use of personal hygiene items, and good sanitation practices, also help prevent the spread of Staphylococcus aureus.

In general, good personal hygiene, taking care of your own health and the health of others, and promptly contacting a doctor in case of suspected infection with Staphylococcus aureus will help prevent its spread and maintain health.

How can I prevent the spread of Staphylococcus aureus?

Staphylococcus aureus is one of the most common pathogens, so it is important to take steps to prevent its spread. Here are some tips:

1. Practice good hand hygiene. Wash your hands regularly with warm water and soap for 20 seconds. If it is not possible to wash your hands, use an antiseptic hand gel.
2. Avoid contact with contaminated surfaces. Staphylococcus aureus can survive on a variety of surfaces, so try to avoid contact with shared items such as towels, bedding, or personal hygiene items.
3. Do not share personal items. Avoid sharing personal hygiene items such as toothbrushes, razors, or manicure utensils.
4. Clean and disinfect surfaces. Clean and disinfect surfaces regularly, especially in public areas such as the kitchen or bathroom.
5. Avoid close contact with infected people. If someone in your community has Staphylococcus aureus, try to avoid close contact with that person, especially if you have open sores or cuts to your skin.

By following these guidelines, you can reduce your risk of contracting Staphylococcus aureus and prevent its spread.

Tips and Tricks for Treating Staphylococcus aureus

Staphylococcus aureus is a bacterium that can cause a variety of infections, including skin, respiratory, and digestive infections. Treatment of this infection requires an integrated approach and adherence to certain recommendations.

It is important to start treating Staphylococcus aureus as soon as symptoms appear. It is recommended to consult a doctor who will diagnose and prescribe the appropriate treatment. Antibiotics are most often used to help kill the bacteria and prevent the spread of the infection.

In addition to taking antibiotics, it is important to practice good hygiene and take steps to prevent the spread of Staphylococcus aureus. Washing your hands regularly and thoroughly with soap and water is recommended, especially after contact with possible sources of infection such as broken skin or contaminated objects.

Medicated ointments or creams containing antibiotics or antiseptics can be used to relieve symptoms and speed up recovery. It is also recommended to avoid hypothermia and injury to the affected areas of the skin so as not to aggravate the infection.

It is important to remember that the treatment of Staphylococcus aureus may take some time, and you must follow the doctor’s recommendations and take all prescribed drugs until the end of the course. In the event of complications or lack of improvement in the condition, it is necessary to consult a doctor again to correct the treatment.

In general, hygiene, use of antibiotics, and proper skin care will help to effectively treat Staphylococcus aureus and prevent its spread.

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Q&A:

How can you get Staphylococcus aureus?

Staphylococcus aureus is spread from person to person, usually through contact with infected surfaces or objects. Transmission through skin contact with an infected person is also possible.

What symptoms can be caused by Staphylococcus aureus?

Staphylococcus aureus can cause a variety of symptoms, including redness and swelling of the skin, blistering or sores, itching, pain, and purulent discharge. In some cases, fever and general malaise may occur.

How is Staphylococcus aureus diagnosed?

Diagnosis of Staphylococcus aureus is usually made by taking a sample from the affected skin or other infected areas. The sample is then analyzed in a laboratory for the presence of bacteria. Additional tests may also be done to determine the susceptibility of bacteria to antibiotics.

How to effectively treat Staphylococcus aureus?

Treatment for Staphylococcus aureus usually involves the use of antibiotics, which are effective against the bacteria. It is important to complete the full course of treatment and take medications as recommended by your doctor. Topical preparations may also be prescribed to treat the affected areas of the skin and reduce symptoms.

What should I do if Staphylococcus aureus does not go away after treatment?

If Staphylococcus aureus does not go away after treatment, it is necessary to consult a doctor for additional research and correction of treatment tactics. You may need to change antibiotics or use other treatments.

How can infection with Staphylococcus aureus be prevented?

To prevent infection with Staphylococcus aureus, it is recommended to maintain good hygiene, wash hands regularly with soap and water, avoid contact with infected surfaces and objects, do not share personal items with other people, cover wounds and cuts with bandages or plasters.

Reviews

Alexey Petrov

The article is very useful and informative! I’m very glad I stumbled upon it, as I recently had problems with Staphylococcus aureus. The author talks in detail about the causes of this infection and how to treat it effectively. I especially liked that the article contains not only medical methods of treatment, but also recommendations for strengthening the immune system and preventing the disease. Now I know exactly what to do if I get symptoms of Staphylococcus aureus. Many thanks to the author for such useful information!

Ivan Sidorov

The article is very useful and informative! As a woman, I always pay special attention to my health and the health of my family. Staphylococcus aureus is a serious disease that requires immediate treatment. I found in the article a lot of useful tips and recommendations that will help me fight this infection. I especially liked that the author described in detail the main symptoms of the disease and suggested various methods of treatment. Now I know how to properly care for the skin to prevent the spread of infection, and what drugs to use for effective treatment. Thanks to the author for the valuable information! Now I feel more confident and ready to take all the necessary measures to combat Staphylococcus aureus.

Sergey Smirnov

The article is very useful and informative. I suffered from Staphylococcus aureus for a long time and did not know how to deal with this problem. Thanks to this article, I learned a lot of useful tips and recommendations for the effective treatment of this disease. I especially liked the fact that the author described in detail the causes of Staphylococcus aureus and gave recommendations for prevention. Now I know how to properly care for my skin to prevent re-infection. It is also worth noting that the author shared his experience of treating Staphylococcus aureus and talked about various methods and drugs that help get rid of this bacterium. Overall, the article is very helpful and I would recommend it to anyone who suffers from Staphylococcus aureus.

Ekaterina Smirnova

The article is very useful and informative! I have been struggling with Staphylococcus aureus for quite a long time, and all the advice offered seems to me very valuable. I especially liked that the author described in detail the causes of this bacterium and its symptoms. Now I know exactly what signs to look out for in order to start treatment on time. Also in the article are very useful tips for the treatment of Staphylococcus aureus. I have tried different methods in the past, but not all have been effective. Now I have new ideas that I will definitely try. I was especially interested in the use of antibiotics and topical preparations, as well as the regular washing and disinfection of personal hygiene items. Thanks to the author for such useful information! I am sure that it will help many people suffering from Staphylococcus aureus. Now I know how to properly treat this infection and what to do to prevent it from reappearing. I will recommend this article to my friends and acquaintances who are also struggling with this problem.

Anastasia Ivanova

The article is very useful and informative. I suffered from Staphylococcus aureus for a long time and was constantly looking for effective ways to treat it. I’m very glad I stumbled upon this article. In it, I found many useful tips and recommendations that helped me deal with this problem. I especially liked the fact that the author described in detail the causes of Staphylococcus aureus and talked about various methods of treatment. Thank you very much for the information about the use of antibiotics and local treatment. Now I know how to use these remedies correctly and how long to continue treatment. It is also worth noting useful tips for preventing relapses and strengthening immunity. The article really helped me understand the causes and effective treatments for Staphylococcus aureus. Many thanks to the author for such useful information!

causes, types, treatment, preparations and ointments

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3. Impetigo: treatment and preparations

What is impetigo and how does it look like?

Impetigo is a common skin infection transmitted by direct contact with rashes. The disease is most common in children, but it can also appear at a later age.

Peak incidence occurs in summer and autumn, warm and humid climate favors the spread ² . The disease is contagious and is transmitted during direct contact with the skin of a sick person.

Often, outbreaks occur within families or in places of close contact, such as kindergartens or the military.

People with diabetes or a weakened immune system (eg after chemotherapy) are also prone to impetigo.

Impetigo causative agents

Impetigo is usually caused by one of two types of bacteria or a combination of them:

• Staphylococcal impetigo
• Streptococcal impetigo
• Streptostaphylococcal impetigo

Currently, the most frequently detected pathogen is Staphylococcus aureus (S. aureus) ¹ , some species of which, for example, methicillin-resistant aureus staphylococcus aureus are resistant to many antibiotics.

Types of impetigo

Primary impetigo

In primary impetigo, the infection affects the healthy layers of the skin.

Secondary impetigo

Secondary impetigo occurs when an infection attaches to an existing disease.

For example , areas affected by eczema or psoriasis, as well as damaged skin, may develop secondary impetigo. Children infected with scabies are 12 times more likely to develop impetigo than children with healthy skin.

Also classified as non-bullous, bullous
(blistering) or ecthyma (ulcerative impetigo) ^4.11 .

Non-bullous impetigo

Non-bullous impetigo is the most common form of the disease caused by Staphylococcus aureus and/or group A beta-hemolytic streptococcus, accounting for 70-80% of cases ^{2, 3} .

Rash usually appears 4-10 days after infection. At first, small fluid blisters form on the skin, which often go unnoticed as they quickly burst, leaving scab-like patches on the skin. Sometimes only one blister may appear, which is a moist golden crust on the skin, under which inflammation develops.

It happens that the affected areas simply look reddened and inflamed, as the crusts are removed or combed.

Impetigo most often affects the face, but can also occur on other areas of the skin. The size of the lesions varies, but they are usually quite small – about a centimeter at the onset of the disease. In the future, impetigo may grow, with smaller spots forming around the first spot.

Bullous impetigo

Bullous impetigo is almost always caused by Staphylococcus aureus ² .

This type of impetigo is characterized by the presence of large bullae. The skin at the top of such a blister is very thin and easily damaged, it bursts, leaving large red irritated spots.

Impetigo may occur on the face, arms, legs or buttocks. It is most likely to appear on skin already affected by other diseases (for example, in areas with eczema).

Ecthyma

This is a less common type of impetigo that causes sores on the skin.

Diagnosis of impetigo

The diagnosis is made by a dermatologist on the basis of anamnesis, visual examination and various research methods ^2.9 :

• Visual examination allows you to see the microstructure of the skin in detail.
• Microscopic examination. Used to determine the type of pathogen and form of impetigo.
• Clinical blood test. Allows you to identify the presence of common diseases associated with the occurrence of impetigo.
• Microscopy of smears of discharge from the affected areas is necessary to identify the pathogen and confirm the diagnosis.
• Bacterial inoculation consists in the fact that the discharge from the affected areas is “sown” on special nutrient media, on which microorganisms actively grow and multiply. Sowing allows not only to identify the pathogen, but also to analyze the reaction of bacteria to various antimicrobial drugs. Most often, this research method is used for suspected methicillin-resistant (methicillin-resistant) staphylococcus aureus (MRSA) or when investigating an outbreak of impetigo in any group.

How is impetigo treated?

The goal of treatment is to eliminate the pain caused by lesions, unaesthetic manifestations of the disease (especially on the face), and to prevent the spread of infection or the development of complications.

As a rule, impetigo is treated with local remedies – ointments, creams, solutions. However, in some cases antibiotic treatment is indicated. This includes the following situations:

• The rash affects large areas of the body.
• Infection continues to spread despite topical treatment.
• The infection returns after the end of treatment.
• Reduced immunity.
• General malaise due to high fever and sore throat.

  In such cases, oral (by mouth) antibiotics are indicated for 7 days. The selection of an antimicrobial drug is carried out by a doctor, based on many factors in a particular patient (pathogen sensitivity, allergic reactions, etc.).

  The use of antibacterial drugs does not exclude local antiseptic treatment, for example, with a solution of povidone-iodine.

Povidone iodine

Characteristics and properties of povidone iodine. What is povidone-iodine used for? Instructions for use of the solution, ointment, suppositories Betadine ^® with povidone-iodine.

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Topical treatment of impetigo

Uncomplicated impetigo responds well to topical treatment.

Treatment options for impetigo include the following ointments and creams:

• Keratolytic ointments based on sulfur, salicylic acid. Used to soften and partially dissolve the stratum corneum of the skin.
• Topical disinfectants – povidone-iodine and chlorhexidine, hexachlorophene.
  Used to disinfect damaged skin areas.
• Antibacterial ointments/creams – eg neomycin, bacitracin, polymyxin B, gentamicin, fusidic acid, mupirocin, retapamulin.
• Combination corticosteroid ointments/creams (combination of steroids and antibiotics) – betamethasone + gentamicin, hydrocortisone + neomycin + netamycin, betamethasone + fusidic acid. Used to reduce inflammation and eliminate severe itching.

At the time of treatment, it is recommended to refrain from visiting public places and contact with other people for at least 24-48 hours. In addition, it is forbidden to wash the affected areas. The skin around the foci must be wiped with antiseptic preparations. The nails are cut short, the subungual folds are smeared with an iodine solution, for example, povidone-iodine (Betadine ^® ) ^4.5 .

The use of topical antimicrobials in the treatment of impetigo can greatly facilitate the healing process of lesions. Antiseptics have a wide spectrum of activity against bacteria, fungi and viruses, so they are well suited for the treatment of various skin lesions and related complications.

Treatment of impetigo with iodine preparations (Betadine®)

Preparations based on povidone-iodine ( Betadine ^® ) have a wide spectrum of antimicrobial activity, are active against gram-positive bacteria (staphylococci and streptococci), gram-negative bacteria, fungi and viruses ^7.8 .

In addition, povidone-iodine ( Betadine ^® ) is active in vitro against biofilms formed by P. organisms. A protective “dome” is created in the biofilm, which reduces the effectiveness of both drugs and human antimicrobial immune cells. Therefore, wounds heal slowly, and the infection does not go away.

To date, there is no evidence that pathogens can be resistant to povidone-iodine, which makes it a key advantage in an era when resistance to antiseptics and antibiotics is steadily increasing ⁶ .

Preparations Betadine ^® , in contrast to alcohol solutions of iodine and brilliant green, do not cause burning and persistent staining of the skin, which is especially important when treating affected areas in children and adults.

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Prevention of impetigo

Since impetigo is a contagious disease, the following guidelines should be followed ² :

• Try to avoid contact with the rash.
• Wash hands immediately after contact with rashes and after handling skin and applying ointment.
• Use individual towels and other hygiene products until the infection is completely eradicated.
• Children who become ill should not attend school, and adults should remain on sick leave until the skin is completely clear or at least for at least 48 hours after starting antibiotic therapy.
• If ​​impetigo recurs, screening for causative bacteria should be done.

Frequently Asked Questions

What if the treatment does not work?

Be sure to tell your doctor if the prescribed treatment does not help. One of the possible reasons may be the resistance of bacteria to prescribed drugs, in which case a change of antibiotic is necessary. In some cases, it is recommended to take a scraping to identify the causative agent of the infection and choose the optimal treatment regimen.

Which diseases have similar symptoms to impetigo?

Impetigo is often confused with another skin disease, panniculitis, which is a lesion of the deeper layers of the skin. Compared to impetigo, panniculitis has a much larger area of ​​skin involvement, swelling and redness, and no blisters or crusts. Panniculitis requires immediate treatment, especially when it comes to the skin of the face and the area around the eyes.

An impetigo rash near the lips is also often mistaken for a “cold” on the lips, which is a manifestation of a viral infection and can recur in the same place.

Why does impetigo reappear?

Children often have one or two episodes of impetigo. However, some people may suffer from constant relapses. One of the reasons is the presence in the body of the corresponding bacteria, for example, in the nasopharynx. In general, they do not harm health, but can spread over the face and provoke impetigo. If the doctor suspects the presence of bacteria in the body, he may take a swab from the nasopharynx for examination and subsequently prescribe a course of antibiotics.

Which doctor treats impetigo?

Since impetigo is a skin disease, the treating doctor is undoubtedly a dermatologist. Also, in the presence of concomitant diseases and for the correction of treatment, you will need to consult a pediatrician or therapist, depending on the age of the patient.

Tamrazova Olga Borisovna

MD, Professor of the Russian Academy of Sciences, Professor of the Department of Dermatovenereology with a Course of Cosmetology of the FNMO of the Medical Institute of the FGAEI VO RUDN University of the Ministry of Science and Higher Education of the Russian Federation, Moscow.

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Polyvinylpyrrolidone (povidone): application, use in the povidone-iodine complex.

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References

1. Pereira LB. Impetigo review. An Bras Dermatol. 2014;89(2):293-299. doi:10.1590/abd1806-4841.20142283.
2. Nardi NM, Schaefer TJ, Espil MO. Impetigo (Nursing). In: StatPearls. Treasure Island (FL): StatPearls Publishing; August 11, 2021.
3. Abrha S, Tesfaye W, Thomas J. Intolerable Burden of Impetigo in Endemic Settings: A Review of the Current State of Play and Future Directions for Alternative Treatments.