Antibiotics - Topical: Nursing pharmacology

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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

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

"Karch’s Focus on Nursing Pharmacology. 9th edition. ISBN: 978-1-975180-40-9" LWW (2023)

"Pharmacology: A Patient-Centered Nursing Process Approach. 9th edition. ISBN: 978-0-323-39916-6 " Elsevier Canada (2020)

"Mosby’s 2023 Nursing Drug Reference. 36th edition. ISBN: 978-0-323-93072-7" Mosby (2022)

"Saunders Comprehensive Review for the NCLEX-RN. 9th Edition. ISBN: 978-0-323-79530-2" Saunders (2022)

"Topical antibiotics for chronic suppurative otitis media. 1(1):CD013051" Cochrane Database Syst Rev (2020 Jan 2)

"Topical versus systemic antibiotics for chronic suppurative otitis media. 2(2):CD013053" Cochrane Database Syst Rev (2021 Feb 9)

"Infectious keratitis: A review. 50(5):543-562" Clin Exp Ophthalmol (2022)

Antibiotics - Topical: Nursing pharmacology

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