Topical antibacterial agents

Abstract

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.

The Neurostimulation Appropriateness Consensus Committee (NACC) Recommendations for Infection Prevention and Management

“…A fundamental component of the perioperative effort to reduce SSIs is the use of an appropriate skin antiseptic agent and preparation technique. Ideally, antiseptic agents should have the following characteristics: 1) broad‐spectrum antimicrobial activity, 2) rapid bactericidal activity, 3) prolonged efficacy following application, 4) maintenance of bactericidal and bacteriostatic effects in the presence of organic matter, 5) limited systemic exposure, and 6) lack of skin irritant properties .…”

“…Both povidone‐iodine and chlorhexidine‐based products are often combined with isopropyl alcohol. Isopropyl alcohol is an effective bactericidal agent that disorganizes cell membrane lipids and denatures cellular proteins . Isopropyl alcohol has been shown to increase the antimicrobial activity of both products.…”

Topical Antimicrobial Therapy for Treating Chronic Wounds

“…For millennia, healers have applied various compounds to infected wounds, some of which (eg, silver and honey) we still use today. Compared with systemic antibiotic therapy, topical application has many potential advantages, as well as some disadvantages, as outlined in Table 2 [17,18]. To overcome known deficiencies, clinicians and industry have defined the ideal potential topical agent, as summarized in Table 3 [19].…”

Topical versus Systemic Antimicrobial Therapy for Treating Mildly Infected Diabetic Foot Ulcers: A Randomized, Controlled, Double‐Blinded, Multicenter Trial of Pexiganan Cream

“…Pexiganan is not absorbed intact from open wounds, which makes it most suitable for the treatment of mild, relatively superficially infected ulcers. Unlike many topical antimicrobials [12], pexiganan has not provoked allergic sensitization on the basis of data from ∼1300 exposed subjects (M.Z., unpublished data). It has a broad spectrum of activity against the aerobic gram-positive bacteria (including methicillin-resistant S. aureus), aerobic gram-negative bacteria, and obligate anaerobes [18,19,21,22] that typically cause DFIs.…”

“…of agents not available for systemic therapy [12]. An acceptable topical anti-infective agent would need to demonstrate activity against the spectrum of bacteria that are known to cause DFI, and it would need to avoid serious adverse effects, interference with wound healing, or induction of drug resistance.…”