Review - Expert Opinion on Antibiotics and Antibiotic Resistance in Dermatology
Keywords:
antibiotic, resistance, burns, wounds, acne, inflammationAbstract
Introduction: Antibiotic resistance has become a serious, severe problem worldwide. This issue does not only relate to the use of systemic antibiotics but to topical ones as well, like systemic therapies and local treatment of skin and mucosal infections. Antiseptics, an alternative to the topical treatment with antibiotics of wounds and some inflammatory dermatological conditions, tend to be microbicidal and have a broader spectrum of antimicrobial activity than antibiotics. Among these, polyhexanide (PHMB) allows for the control of the infection while avoiding the development of resistance.
Objectives: Recommendations on the rules of good clinical practice for the management of small wounds, burns and post-traumatic ulcerative wounds, impetigo or folliculitis in the initial stages, and acne.
Methods: Literature review on the principal topical therapies for small wounds, injuries, impetigo, folliculitis, and acne and a proposal of innovative, highly-tolerated treatments.
Results and conclusions: Given the abuse of topical antibiotics in dermatology, for the treatment of small wounds, injuries, localized folliculitis, impetigo, and acne, the use of alternative topical treatments like polyhexanide and Rigenase® is recommended.
References
WHO. 2021 AWaRec classification. https://www.who.int/publications/i/item/2021-aware-classification. Accessed: July 12, 2024.
Kramer A, Dissemond J, Kim S, et al. Consensus on wound antisepsis: update 2018. Skin Pharmacol Physiol 2018;31(1):28-58. DOI: 10.1159/000481545. PMID: 29262416
Patel DJ, Bhatia N. Oral antibiotics for acne. Am J Clin Dermatol 2021 Mar;22(2):193-204. DOI: 10.1007/s40257-020-00560-w PMID: 32918267.
Schwartzman G, Khachemoune A. Surgical site infection after dermatologic procedures: critical reassessment of risk factors and reappraisal of rates and causes. Am J Clin Dermatol 2021 Jul;22(4):503-510. DOI: 10.1007/s40257-021-00599-3. PMID: 33797060
Ruffolo AM, Sampath AJ, Colbert S, Golda N. Preoperative considerations for the prevention of surgical site infection in superficial cutaneous surgeries: a systematic review. Facial Plast Surg Aesthet Med. 2021; 23(3):205-223. DOI: 10.1089/fpsam.2020.0100. PMID: 32721241
Zuzanna ŁB, Marzena KP, Tomasz MK. Wound Antiseptics and European Guidelines for Antiseptic Application in Wound Treatment. Pharmaceuticals (Basel) 2021 Dec 2;14(12):1253. DOI: 10.3390/ph14121253. PMID: 34959654
Stryja J, Teplá K, Routek M, Pavlík V, Perutková D. Octenidine with hyaluronan dressing versus a silver dressing in hard-to-heal wounds: a post-marketing study. J Wound Care 2023 Aug 2;32(8):480-491. DOI: 10.12968/jowc.2023.32.8.480 PMID: 375723398.
Chansanti O, Mongkornwong A. Treating hard-to-heal ulcers: biocellulose with nanosilver compared with silver sulfadiazine. J Wound Care 2020 Dec 1;29(Sup12):S33-S37. DOI: 10.12968/jowc.2020.29.Sup12.S33. PMID: 33320764
Eggers M. Infectious disease management and control with povidone iodine. Infect Dis Ther 2019 Dec;8(4):581-593. DOI: 10.1007/s40121-019-00260-x. PMID: 31414403.
Balagopal S, Arjunkumar R. Chlorhexidine: the gold standard antiplaque agent. J Pharmaceutical Sci Res. 2013;5(12):270-274.
Schiavo G, Falciglia D, Maurelli S, et al. In vitro evaluation of the antimicrobial activity of a topical skin preparation containing 0.1% polyhexanide vs a topical skin preparation containing 1% silver sulfadiazine. J Clin Dermatol Ther. 2020;6:055.
Ciprandi G, Sharon R, Ludmilla B, et al. A retrospective systematic data review on the use of a polyhexanide-containing product on burns in children. J Tissue Viability 2018 Nov;27(4):244-248. doi: 10.1016/j.jtv.2018.08.001. PMID: 30170891.
Russo R, Carrizzo A, Barbato A, et al., Clinical evaluation of the efficacy and tolerability of Rigenase® and polyhexanide (Phytostimoline® Plus) vs. hyaluronic acid and silver sulfadiazine (Connettivina® Bio Plus) for the treatment of acute skin wounds: a randomized trial. J Clin Med 2022 Apr 29;11(9):2518. doi: 10.3390/jcm11092518 PMID: 35566643.
Phillips TJ. Chronic cutaneous ulcers: etiology and epidemiology. J Invest Dermatol. 1994;102(6):38S-41S. DOI:10.1111/1523-1747.ep12388556.
Lazarus GS, Cooper DM, Knighton DR, et al. Definitions and guidelines for assessment of wounds and evaluation of healing. Arch Dermatol. 1994;130(4), 489–493. PMID: 8166487.
Elston DM. Topical antibiotics in dermatology: emerging patterns of resistance. Dermatol Clin 2009 Jan;27(1):25-31. DOI: 10.1016/j.det.2008.07.004. PMID: 18984365.
Amirthalingam S, Yi CS, Ching LT, Mun NY. Topical antibacterials and global challenges on resistance development. Trop. j. pharm. res. 2015;14(5):919-924. DOI: 10.4314/tjpr.v14i5.24.
Shah RA, Joanne IH, Ravi RP, et al. Antibiotic resistance in dermatology: The scope of the problem and strategies to address it. J Am Acad Dermatol 2022 Jun;86(6):1337-1345. doi: 10.1016/j.jaad.2021.09.024. PMID: 34555484.
Agency for Clinical Innovation. Burn Patient Management Clinical Guidelines. 2019. https://aci.health.nsw.gov.au/__data/assets/pdf_file/0009/250020/ACI-Burn-patient-management-guidelines.pdf. Accessed: July 12, 2024.
ISBI Practice Guidelines Committee; Steering Subcommittee; Advisory Subcommittee, ISBI Practice Guidelines for Burn Care. Burns. 2016;42(5):953-1021.
Cancio LC. Topical antimicrobial agents for burn wound care: history and current status. Surg Infect (Larchmt) 2021 Feb;22(1):3-11. doi: 10.1089/sur.2020.368. PMID: 33124942.
Venturi M, Orlandi C, Biondo R, Melandri D. Ustioni Ambulatoriali - protocolli di gestione. Linee Guida ADOI 2021 https://www.adoi.it/wp-content/uploads/2020/05/USTIONI-AMBULATORIALI-protocolli-di-gestione.pdf. Accessed: July 12, 2024.
Herndon DN. Total Burn Care. 4th ed. Elsevier, 2012.
Barajas-Nava LA, López-Alcalde J, Roqué i Figuls M, et al. Antibiotic prophylaxis for preventing burn wound infection. Cochrane Database Syst Rev. 2013;6:(6):CD008738 DOI: 10.1002/14651858.CD008738.pub2 PMID: 23740764.
Csenkey A, Jozsa G, Gede N, et al. Systemic antibiotic prophylaxis does not affect infectious complications in pediatric burn injury: A meta-analysis. PLoS One. 2019; 25;14(9):e0223063. DOI: 10.1371/journal.pone.0223063. PMID: 31553768.
Ribhi S, Scangarella-Oman N, Dalessandro MB, et al. Topical retapamulin in the management of infected traumatic skin lesions Ther Clin Risk Manag. 2009;5:41-49. DOI: 10.2147/tcrm.s3459 PMID: 19436611.
Cicuttin E, Sartelli M, Scozzafava E, et al. Antibiotic prophylaxis in torso, maxillofacial, and skin traumatic lesions: a systematic review of recent evidence Antibiotics (Basel). 2022, 21;11(2):139. DOI: 10.3390/antibiotics11020139. PMID: 35203743.
Petersen K. Waterman P. Prophylaxis and treatment of infections associated with penetrating traumatic injury. Expert Rev Anti Infect Ther. 2011;9(1):81-96. DOI: 10.1586/eri.10.155. PMID: 21171880.
O’Meara S, Al-Kurdi D, Ologun I, et al., Antibiotics and antiseptics for venous leg ulcers. Cochrane Database Syst Rev. 2014 (1): CD003557. DOI: 10.1002/14651858.CD003557.pub5 PMID: 24408354.
Chaplin S. NICE on antimicrobial prescribing for leg ulcer infection. Prescriber. 2020;31(7-8):27-30. DOI: 10.1002/psb.1858.
De Groot A. Allergic contact dermatitis from topical drugs: an overview. Dermatitis. 2021;32(4):197-213. DOI: 10.1097/DER.0000000000000737. PMID: 34415695
Goossens A, Gonçalo M. Contact allergy to topical drugs. Contact Dermatitis. 2013;68(5):257-258.
Stevens DL Bryant AE, Ferretti JJ, Stevens DL, Fischetti VA, eds. Streptococcus pyogenes impetigo, erysipelas, and cellulitis. In: Streptococcus pyogenes: Basic Biology to Clinical Manifestations. 2nd edition. Oklahoma City (OK): University of Oklahoma Health Sciences Center; 2022, Chapter 23. PMID: 36479753
Galli L, Novelli A, Ruggiero G, et al. Pediatric impetigo: an expert panel opinion about its main controversies. J Chemother. 2022;34(5):279-285. DOI: 10.1080/1120009X.2021.1961185. PMID: 34405763.
Dollani LC, Marathe KS. Impetigo/staphylococcal scalded skin disease. Pediatr Rev. 2020;41(4):210-212. DOI: 10.1542/pir.2018-0206. PMID: 32238552.
Schachner LA, Lynde CW, Kircik LH, et al., Treatment of impetigo and antimicrobial resistance. J Drugs Dermatol. 2021;20(4)):366-372. DOI: 10.36849/JDD.2021.5795. PMID: 33852242.
Luelmo-Aguilar J, Santandreu MS. Folliculitis: recognition and management. Am J Clin Dermatol. 2004;5(5):301-310. DOI: 10.2165/00128071-200405050-00003. PMID: 15554731.
Mills O Jr, Thornsberry C, Cardin C, et al. Bacterial resistance and therapeutic outcome following three months of topical acne therapy with 2% erythromycin gel versus its vehicle. Acta Derm Venereol. 2002;82(4):260-265. DOI: 10.1080/000155502320323216. PMID: 12361129.
Levy RM, Huang EY, Roling D, Leyden JJ, Margolis DJ. Effect of antibiotics on the oropharyngeal flora in patients with acne. Arch Dermatol. 2003;139(4):467-471. DOI:10.1001/archderm.139.4.467.
Thiboutot D, Gollnick H, Bettoli V, et al. New insights into the management of acne: an update from the Global Alliance to Improve Outcomes in Acne group. J Am Acad Dermatol. 2009;60(5 Suppl):S1-S50. DOI:10.1016/j.jaad.2009.01.019.
Bettoli V, Antonioli P, Barbareschi M, et al. Acne, terapia antibiotica e antibiotico-resistenza: la posizione dei dermatologi italiani. Esperienze Dermatologiche. 2016;18(1):34-37.
Veraldi S, Schianchi R. Efficacy and Tolerability of a Cream Containing Polyhexanide and Rigenase® for the Prevention of Bacterial Superinfections of the Skin after Minor Surgical Procedures. Clin Exp Dermatol Ther. 2023;8:200. DOI: 10.29011/2575-8268.100200.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Giuseppe Argenziano, Marco Ardigò, Giuseppe Micali, Maria Rita Nasca, Alessandra Scilletta, Linda Tognetti, Pietro Rubegni, Stefano Veraldi
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Dermatology Practical & Conceptual applies a Creative Commons Attribution License (CCAL) to all works we publish (http://creativecommons.org/licenses/by-nc/4.0/). Authors retain the copyright for their published work.