Topical antibacterial agents occupy an important niche of antimicrobial therapy for both inpatients and outpatients. These agents, including antiseptic and antibiotic preparations, are used for prophylaxis and treatment of infection. Prophylactic uses include application for traumatic and surgical wounds, burns, intravascular catheters, and eradication of S. aureus nasal carriage. Topical antibacterial agents are also used for treatment of primary and secondary pyodermas. Individual antibacterial agents have been reviewed. Of note, despite the widespread use of topical antibacterial agents, further data on which to guide therapy are needed in many instances.

A persistent change in ocular alignment after uneventful cataract surgery occurred in 7% of patients. However, symptomatic diplopia was uncommon (1 in 118; 0.85%) in this relatively small series.

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"Opaque" physical sunscreens are important for photoprotection of individuals with visible light and UV-A photosensitivity such as those with porphyria, drug photoallergy, and polymorphous light eruption. Diffuse spectral transmittance of various thicknesses of opaque sunscreen formulations were measured from 350- to 800-nm range using a spectrophotometer equipped with an integrating sphere. Transmission through 20% zinc oxide paste was high and decreased minimally despite large increases in the sunscreen layer thickness. Adding a visible light absorber such as iron oxide to scattering sunscreens, however, substantially lowered transmittance below that predicted by the product of the transmittances for each component alone. Opaque sunscreens protected against hematoporphyrin derivative photosensitization of albino guinea pig skin; these results were quantitatively consistent with the in vitro findings. Poor photoprotection against visible light is obtained with white paste sunscreens, even if thick layers are applied. The addition of pigments to such sunscreens, however, greatly enhances photoprotection and cosmetic acceptability.

Prostaglandin formation is enhanced in vascular disease, in part through induction of cyclooxygenase (COX-2) in vascular smooth muscle cells. Because COX regulates cell growth and migration, we examined whether the COX expression plays a role in the development of intimal hyperplasia after vascular injury. Rats undergoing balloon angioplasty of the carotid artery were randomized to receive a selective COX-2 inhibitor (SC-236), a selective COX-1 inhibitor (SC-560) or a combination of the two. Normal, uninjured vessels showed COX-1, but no COX-2 expression. Fourteen days after balloon injury, both COX-1 and COX-2 were expressed in the neointima. Balloon angioplasty resulted in a marked increase in the urinary excretion of prostaglandin (PG) E 2, PGF 2␣ , and thromboxane (TX) B 2 . Both the COX-1 inhibitor SC-560 and the COX-2 inhibitor SC-236 suppressed the generation of PGE 2 and PGF 2␣ , particularly when combined, suggesting a role for both isozymes in the generation of prostaglandins in this model. In contrast, TXA 2 was markedly suppressed by the COX-1 inhibitor SC-560. COX-2 inhibition with SC-236 had no effect on intimal hyperplasia at day 14 (0 versus 8.5%; n ϭ 7 in controls). In contrast, intimal hyperplasia was reduced by SC-560 when administered alone (by 42%; n ϭ 7, p Ͻ 0.05) or in combination with SC-236 (by 40%; n ϭ 7, p Ͻ 0.05). COX-1 may play a role in the development of intimal hyperplasia, potentially through the inhibition of platelet TXA 2 . Despite being expressed in the neointima, COX-2 does not play a role in the development of intimal hyperplasia after vascular injury.Prostaglandin generation is enhanced in patients with atherosclerosis and after balloon angioplasty (Braden et al., 1991;Belton et al., 2000). The products include prostacyclin (PGI 2 ) from vascular endothelium and thromboxane A 2 , which is largely derived from platelets. Prostaglandins are synthesized from arachidonic acid by the enzyme cyclooxygenase (COX

Decreased systemic toxicity, ease of application, and increased concentration at the target site are some of the important advantages topical antibacterial agents offer. This article reviews the literature on selected indications of these agents and provides in-depth examination of specific agents for the prophylaxis and treatment of skin and wound infections.

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