Antibiotics - Topical: Nursing pharmacology

Antibiotics - Topical: Nursing pharmacology

pharm

pharm

Pharmacokinetics - Absorption: Nursing pharmacology
Pharmacokinetics - Distribution: Nursing pharmacology
Pharmacokinetics - Metabolism: Nursing pharmacology
Pharmacokinetics - Elimination: Nursing pharmacology
Pharmacodynamics: Nursing pharmacology
Anthelmintics: Nursing pharmacology
Antibiotics - Aminoglycosides: Nursing pharmacology
Antibiotics - Beta lactam and beta lactamase inhibitor combinations: Nursing pharmacology
Antibiotics - Antimycobacterials: Nursing pharmacology
Antibiotics - Carbapenems and monobactams: Nursing pharmacology
Antibiotics - Cephalosporins: Nursing pharmacology
Antibiotics - Cyclic lipopeptides: Nursing pharmacology
Antibiotics - Fluoroquinolones: Nursing pharmacology
Antibiotics - Lincosamides: Nursing pharmacology
Antibiotics - Glycopeptides: Nursing pharmacology
Antibiotics - Macrolides: Nursing pharmacology
Antibiotics - Metronidazole: Nursing pharmacology
Antibiotics - Oxazolidinones: Nursing pharmacology
Antibiotics - Penicillins: Nursing pharmacology
Antibiotics - Tetracyclines and glycylcyclines: Nursing pharmacology
Antibiotics - Trimethoprim and sulfonamides: Nursing pharmacology
Antibiotics - Polymyxins: Nursing pharmacology
Antimalarials: Nursing pharmacology
Antiretrovirals for HIV/AIDS - CCR5 antagonists, fusion inhibitors, and attachment inhibitors: Nursing pharmacology
Antiprotozoals: Nursing pharmacology
Antiretrovirals for HIV/AIDS - NRTIs and NNRTIs: Nursing pharmacology
Antiretrovirals for HIV/AIDS - Integrase strand transfer inhibitors: Nursing pharmacology
Antivirals for herpesviruses: Nursing pharmacology
Antiretrovirals for HIV/AIDS - Protease inhibitors: Nursing pharmacology
Antivirals for hepatitis B and C: Nursing pharmacology
Antivirals for influenza: Nursing pharmacology
Medications for respiratory syncytial virus (RSV): Nursing pharmacology
Chloramphenicol: Nursing pharmacology
Alpha-1 adrenergic blockers: Nursing pharmacology
Alpha-2 adrenergic agonists: Nursing pharmacology
Angiotensin II receptor blockers (ARBs): Nursing pharmacology
Angiotensin-converting enzyme (ACE) inhibitors: Nursing pharmacology
Antiarrhythmics: Nursing pharmacology
Beta-adrenergic blockers: Nursing pharmacology
Calcium-channel blockers: Nursing pharmacology
Cardiac glycosides: Nursing pharmacology
Direct-acting vasodilators: Nursing pharmacology
Nitrates: Nursing pharmacology
Sympathomimetic medications: Nursing pharmacology
Glucocorticoids and mineralocorticoids: Nursing pharmacology
Insulin: Nursing pharmacology
Medications affecting the parathyroid glands: Nursing pharmacology
Medications for antidiuretic hormone (ADH) disorders: Nursing pharmacology
Medications for thyroid disorders: Nursing pharmacology
Medications for growth hormone disorders: Nursing pharmacology
Oral antidiabetic medications - Biguanides and thiazolidinediones: Nursing pharmacology
Oral antidiabetic medications - Alpha-glucosidase inhibitors: Nursing pharmacology
Oral antidiabetic medications - DPP-4 inhibitors: Nursing pharmacology
Oral antidiabetic medications - Sulfonylureas and meglitinides: Nursing pharmacology
Oral antidiabetic medications - Sodium-glucose co-transporter-2 (SGLT-2) inhibitors: Nursing pharmacology
Antiglaucoma medications: Nursing pharmacology
Mydriatics and cycloplegics: Nursing pharmacology
Eye anesthetics: Nursing pharmacology
Ophthalmic anti-inflammatories and anti-infectives: Nursing pharmacology
Antacids: Nursing pharmacology
Antidiarrheals: Nursing pharmacology
Laxatives: Nursing pharmacology
Histamine H2 antagonists: Nursing pharmacology
Antihyperlipidemics - Bile acid sequestrants and cholesterol absorption inhibitors: Nursing pharmacology
Anticoagulants - Warfarin: Nursing pharmacology
Antihyperlipidemics - Fibrates: Nursing pharmacology
Antihyperlipidemics - Statins: Nursing pharmacology
Antiplatelet agents: Nursing pharmacology
Antihyperlipidemics - Miscellaneous: Nursing pharmacology
Blood products: Nursing pharmacology
Hematopoietic growth factors: Nursing pharmacology
Iron preparations: Nursing pharmacology
Hemostatics: Nursing pharmacology
Thrombolytics: Nursing pharmacology
Antirejection immunosuppressants: Nursing pharmacology
Biologic agents: Nursing pharmacology
Immunoglobulins: Nursing pharmacology
Disease-modifying therapy for multiple sclerosis: Nursing pharmacology
Immunosuppressants for autoimmune diseases: Nursing pharmacology
Immunomodulators: Nursing pharmacology
Vaccines: Nursing pharmacology
Debridement agents: Nursing pharmacology
Keratolytics: Nursing pharmacology
Antibiotics - Topical: Nursing pharmacology
Medications for acne vulgaris: Nursing pharmacology
Antifungals - Topical: Nursing pharmacology
Corticosteroids - Topical: Nursing pharmacology
Analgesics for obstetrics: Nursing pharmacology
Ergot alkaloids: Nursing pharmacology
Neonatal eye prophylaxis: Nursing pharmacology
Lung surfactants and antenatal corticosteroids: Nursing pharmacology
Oxytocin: Nursing pharmacology
Phytonadione (Vitamin K1): Nursing pharmacology
Rho(D) immune globulin: Nursing pharmacology
Prostaglandins: Nursing pharmacology
Tocolytics: Nursing pharmacology
Antidepressants - SSRIs and SNRIs: Nursing pharmacology
Antidepressants - Tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs): Nursing pharmacology
Anxiolytics and sedative-hypnotics: Nursing pharmacology
Antipsychotics: Nursing pharmacology
Stimulant medications for attention-deficit hyperactivity disorder (ADHD): Nursing pharmacology
Mood stabilizers: Nursing pharmacology
Acetylcholinesterase inhibitors for myasthenia gravis: Nursing pharmacology
Analgesics: Nursing pharmacology
Medications for Alzheimer disease: Nursing pharmacology
Antiepileptics: Nursing pharmacology
Medications for migraines: Nursing pharmacology
Skeletal muscle relaxants: Nursing pharmacology
Alkylating agents: Nursing pharmacology
Angiogenesis inhibitors: Nursing pharmacology
Antitumor antibiotics: Nursing pharmacology
Antimetabolites: Nursing pharmacology
Hormones and hormone modulators for cancer: Nursing pharmacology
Other antineoplastics: Nursing pharmacology
Platinum-based agents: Nursing pharmacology
Plant extracts for chemotherapy: Nursing pharmacology
Antihistamines: Nursing pharmacology
Bronchodilators: Nursing pharmacology
Mast cell stabilizers - Inhaled: Nursing pharmacology
Corticosteroids - Inhaled: Nursing pharmacology
Leukotriene modifiers: Nursing pharmacology
Medications to control airway secretions: Nursing pharmacology
Respiratory stimulants: Nursing pharmacology
Oxygen therapy: Nursing pharmacology

Notes

TOPICAL ANTIBIOTICS
DRUG NAME
bacitracin-polymyxin B (Polysporin)
mafenide (Sulfamylon)

silver sulfadiazine (Silvadene, SSD)
CLASS
Topical antibiotics
MECHANISM OF ACTION
Interferes with bacterial growth
Blocks bacterial proliferation by inhibiting their cell wall synthesis
Kills bacteria by acting on their cell membrane and wall
INDICATIONS
Burns, skin infections
ROUTE(S) OF ADMINISTRATION
TOP
SIDE EFFECTS
  • Skin irritation
  • Urticaria
  • Skin irritation
  • Burning sensation
  • Urticaria
  • Swelling
  • Metabolic acidosis
  • Hemolytic anemia (G6PD deficiency)
  • Burning sensation
  • Temporary black discoloration
  • Erythema multiforme
  • Skin necrosis
  • Stevens-Johnson syndrome or toxic epidermal necrolysis
  • Leukopenia
  • Interstitial nephritis
CONTRAINDICATIONS AND CAUTIONS
  • Pregnancy and breastfeeding
  • Eczema
  • Viral skin infections
  • Prolonged use
  • Mafenide acetate: G6PD deficiency, pulmonary or renal disease
NURSING CONSIDERATIONS: TOPICAL ANTIBIOTICS
ASSESSMENT AND MONITORING
All topical antibiotics
  • Assess the affected area
    • Location and size of wound, laceration, incision
    • Presence of drainage, odor, redness, warmth, swelling, pain
    • Sutures / staples intact
    • Edges of wound approximated
CLIENT EDUCATION
All topical antibiotics
  • Purpose of medication: prevent infection
  • Avoid immersing the wound in water
  • Application technique
    • Wash hands before and after application
    • Cleanse with mild soap and water; gently pat dry
    • Apply the medication
    • Cover it with a sterile dressing as directed
    • Avoid mucous membranes like the eyes and nose
  • Side effects: mild skin irritation or itching
  • Report: increase in side effects; redness, swelling, warmth, bleeding, purulent discharge, dehiscence
Author: Antonia Syrnioti, MD
Author: Ashley Mauldin, MSN, APRN, FNP-BC
Illustrator: Robyn Hughes, MScBMC

Transcript

Watch video only

Topical antibiotics are medications used to prevent or treat infections in damaged skin, including burns, wounds, cuts, or scrapes, as well as surgical incisions.

Some of the most commonly used topical antibiotics include bacitracin-polymyxin B, as well as mafenide acetate, and silver sulfadiazine.

These are non-prescription antibiotics that are applied locally in the form of an ointment. Once applied, they prevent infections by interfering with bacterial growth and proliferation.

In terms of side effects, topical use of bacitracin-polymyxin B usually doesn’t cause any adverse reactions, but some clients may present with mild skin irritation or urticaria.

On the other hand, mafenide can cause mild skin irritation and a burning sensation. Less frequent but more severe side effects include hypersensitivity reactions leading to urticaria, as well as swelling of the face, lips, tongue, or throat.

Mafenide can also cause metabolic acidosis, and some clients with G6PD deficiency have developed fatal hemolytic anemia with disseminated intravascular coagulation.

Lastly, silver sulfadiazine can leave a temporary black discoloration skin, and can cause a burning sensation, a skin rash like erythema multiforme, or even skin necrosis.

Finally, systemic absorption of silver sulfadiazine has also been associated with severe hypersensitivity reactions, such as Stevens-Johnson syndrome and toxic epidermal necrolysis, as well as leukopenia, and interstitial nephritis.

Topical antibiotics should be used with caution during pregnancy and breastfeeding, as well as in clients with a history of other skin conditions, such as eczema, and viral skin infections like herpes, varicella, or shingles.

In addition, prolonged use of topical antibiotics is not recommended, since it can result in bacterial or fungal superinfection.

Finally, mafenide should also be used with caution in clients with G6PD deficiency, as well as pulmonary or renal disease.

Okay, when your client is prescribed a topical antibiotic to prevent or treat infection of a skin wound, first assess the affected area, making note of the presence of any drainage, odor, redness, warmth, swelling, or pain.

Key Takeaways

Topical antibiotics are a type of local antibiotics that are applied directly to the skin or mucous membranes to treat bacterial infections. They are usually in the form of creams, ointments, gels, sprays, or solutions. They work by killing or inhibiting the growth of bacteria on the skin's surface. Common topical antibiotics include mupirocin, neomycin, bacitracin, polymyxin B, mafenide acetate, and silver sulfadiazine.

Topical antibiotics are used to treat a variety of skin infections caused by bacteria, such as impetigo, folliculitis, and cellulitis. They are also used for prophylaxis of surgical site infections and for preventing the spread of infections in wounds and burns. While topical antibiotics are generally considered safe, they can sometimes cause skin irritation, allergic reactions, or antibiotic resistance if misused.

Sources

  1. "Karch’s Focus on Nursing Pharmacology. 9th edition. ISBN: 978-1-975180-40-9" LWW (2023)
  2. "Pharmacology: A Patient-Centered Nursing Process Approach. 9th edition. ISBN: 978-0-323-39916-6 " Elsevier Canada (2020)
  3. "Mosby’s 2023 Nursing Drug Reference. 36th edition. ISBN: 978-0-323-93072-7" Mosby (2022)
  4. "Saunders Comprehensive Review for the NCLEX-RN. 9th Edition. ISBN: 978-0-323-79530-2" Saunders (2022)
  5. "Topical antibiotics for chronic suppurative otitis media. 1(1):CD013051" Cochrane Database Syst Rev (2020 Jan 2)
  6. "Topical versus systemic antibiotics for chronic suppurative otitis media. 2(2):CD013053" Cochrane Database Syst Rev (2021 Feb 9)
  7. "Infectious keratitis: A review. 50(5):543-562" Clin Exp Ophthalmol (2022)