Introduction to Pediatric Topical Antibiotics
Key Principles
- Primary role in treating superficial bacterial skin infections
- Limited systemic absorption when properly used
- Important considerations:
- Local bacterial resistance patterns
- Cost-effectiveness
- Penetration ability
- Contact sensitization risk
Mechanism of Action
- Bacterial cell wall synthesis inhibition
- Protein synthesis inhibition
- DNA synthesis interference
- Cell membrane disruption
Major Antibiotic Classes
Aminoglycosides
- Gentamicin
- Concentration: 0.1%
- Spectrum: Gram-negative organisms
- Indications: Secondary skin infections
- Application: 3-4 times daily
- Neomycin
- Often combined with polymyxin B
- Higher contact sensitization risk
- Limited use due to allergic reactions
Mupirocin
- Properties
- Concentration: 2%
- Excellent activity against S. aureus
- Good MRSA coverage
- Low resistance rates when properly used
- Usage
- Application: 3 times daily
- Duration: 5-10 days
- Reserve for documented infections
Fusidic Acid
- Properties
- Concentration: 2%
- Active against Staphylococci
- Good tissue penetration
- Usage
- Application: 2-3 times daily
- Duration: 7-14 days
- Monitor for resistance
Bacitracin/Polymyxin B
- Combination Benefits
- Broad-spectrum coverage
- Over-the-counter availability
- Cost-effective
- Limitations
- Contact dermatitis risk
- Limited efficacy data
- Not recommended for routine use
Clinical Applications
Primary Indications
- Impetigo
- First-line: Mupirocin
- Alternative: Fusidic acid
- Duration: 5-7 days
- Monitor resolution closely
- Folliculitis
- Mupirocin or fusidic acid
- Consider bacterial culture
- Duration: 7-10 days
- Secondary Infections
- Choose based on suspected organism
- Consider combination therapy
- Monitor primary condition
Treatment Selection
- Consider:
- Local resistance patterns
- Previous antibiotic exposure
- Extent of infection
- Patient allergies
- Cost considerations
Antimicrobial Resistance
Prevention Strategies
- Appropriate Use
- Culture-directed therapy when possible
- Avoid prolonged use
- Reserve stronger agents
- Complete prescribed course
- Monitoring
- Track local resistance patterns
- Regular culture updates
- Document treatment outcomes
Current Concerns
- MRSA emergence
- Mupirocin resistance
- Cross-resistance patterns
- Limited new antibiotic development
Special Considerations
Age-Specific Considerations
- Neonates
- Limited use of topical antibiotics
- Consider systemic therapy
- Monitor absorption carefully
- Infants/Toddlers
- Consider ingestion risk
- Monitor application sites
- Parent education crucial
Application Techniques
- Best Practices
- Clean area before application
- Thin layer application
- Avoid occlusion unless specified
- Regular reassessment
Monitoring Guidelines
- Clinical response within 48-72 hours
- Watch for contact dermatitis
- Document improvement/deterioration
- Consider culture if poor response
Further Reading
