- List articles in this issue
Antimicrobial Activity of Topical Skin Pharmaceuticals – An In vitro Study
The aim of this study was to investigate the antimicrobial activity of currently available topical skin pharmaceuticals against Candida albicans, Escherichia coli, Staphylococcus aureus, Staphylococcus epidermidis and Streptococcus pyogenes. The agar dilution assay was used to determine the minimal inhibitory concentration for cream formulations and their active substances. Corticosteroid formulations with the antiseptics clioquinol or halquinol were active against all microbes. The hydrogen peroxide formulation was primarily active against staphylococci. Clotrimazole, miconazole and econazole showed an effect against staphylococci in addition to their effect on C. albicans. In contrast, terbinafine had no antibacterial effect. Fusidic acid was active against staphylococci, with slightly weaker activity against S. pyogenes and no activity against C. albicans or E. coli. In summary, some topical skin pharmaceuticals have broad antimicrobial activity in vitro, clioquinol and halquinol being the most diverse. In limited superficial skin infection topical treatment can be an alternative to systemic antibiotics and should be considered. With the global threat of multi-resistant bacteria there is a need for new, topical, non-resistance-promoting, antimicrobial preparations for the treatment of skin infections.
Mikael Alsterholm, Nahid Karami, Jan Faergemann
Elston DM. Topical antibiotics in dermatology: emerging patterns of resistance. Dermatol Clin 2009; 27: 25–31.
Shittu AO, Udo EE, Lin J. Phenotypic and molecular characterization of Staphylococcus aureus isolates expressing low- and high-level mupirocin resistance in Nigeria and South Africa. BMC Infect Dis 2009; 9: 10.
Simor AE, Stuart TL, Louie L, Watt C, Ofner-Agostini M, Gravel D, et al. Mupirocin-resistant, methicillin-resistant Staphylococcus aureus strains in Canadian hospitals. Antimicrob Agents Chemother 2007; 51: 3880–3886.
Gupta AK, Cooper EA. Update in antifungal therapy of dermatophytosis. Mycopathologia 2008; 166: 353–367.
Chen SC, Sorrell TC. Antifungal agents. Med J Aust 2007; 187: 404–409.
McDonnell G, Russell AD. Antiseptics and disinfectants: activity, action, and resistance. Clin Microbiol Rev 1999; 12: 147–179.
Whitman TJ. Community-associated methicillin-resistant Staphylococcus aureus skin and soft tissue infections. Dis Mon 2008; 54: 780–786.
Denis O, Deplano A, De Beenhouwer H, Hallin M, Huysmans G, Garrino MG, et al. Polyclonal emergence and importation of community-acquired methicillin-resistant Staphylococcus aureus strains harbouring Panton-Valentine leucocidin genes in Belgium. J Antimicrob Chemother 2005; 56: 1103–1106.
Cercenado E, Cuevas O, Marin M, Bouza E, Trincado P, Boquete T, et al. Community-acquired methicillin-resistant Staphylococcus aureus in Madrid, Spain: transcontinental importation and polyclonal emergence of Panton-Valentine leukocidin-positive isolates. Diagn Microbiol Infect Dis 2008; 61: 143–149.
Osterlund A, Eden T, Olsson-Liljequist B, Haeggman S, Kahlmeter G. Clonal spread among Swedish children of a Staphylococcus aureus strain resistant to fusidic acid. Scand J Infect Dis 2002; 34: 729–734.
Tveten Y, Jenkins A, Kristiansen BE. A fusidic acid-resistant clone of Staphylococcus aureus associated with impetigo bullosa is spreading in Norway. J Antimicrob Chemother 2002; 50: 873–876.
Larsen AR, Skov RL, Jarlier V, Henriksen AS. Epidemiological differences between the UK and Ireland versus France in Staphylococcus aureus isolates resistant to fusidic acid from community-acquired skin and soft tissue infections. J Antimicrob Chemother 2008; 61: 589–594.
Laurent F, Tristan A, Croze M, Bes M, Meugnier H, Lina G, et al. Presence of the epidemic European fusidic acid-resistant impetigo clone (EEFIC) of Staphylococcus aureus in France. J Antimicrob Chemother 2009; 63: 420–421; author reply 1.
Niebuhr M, Mai U, Kapp A, Werfel T. Antibiotic treatment of cutaneous infections with Staphylococcus aureus in patients with atopic dermatitis: current antimicrobial resistances and susceptibilities. Exp Dermatol 2008; 17: 953–957.
Peeters KA. Resistance of Staphylococcus aureus to fusidic acid. Int J Dermatol 2004; 43: 235.
Sule O, Brown NM, Willocks LJ, Day J, Shankar S, Palmer CR, et al. Fusidic acid-resistant Staphylococcus aureus (FRSA) carriage in patients with atopic eczema and pattern of prior topical fusidic acid use. Int J Antimicrob Agents 2007; 30: 78–82.
Birnie AJ, Bath-Hextall FJ, Ravenscroft JC, Williams HC. Interventions to reduce Staphylococcus aureus in the management of atopic eczema. Cochrane Database Syst Rev 2008: CD003871.
Fromtling RA. Overview of medically important antifungal azole derivatives. Clin Microbiol Rev 1988; 1: 187–217.
Susceptibility testing (Swedish Reference Group for Antibiotics). 2004 [cited 2009 Jul 26]. Available from: http: //www.srga.org/RAFMETOD/BASMET.HTM
Mao X, Schimmer AD. The toxicology of clioquinol. Toxicol Lett 2008; 182: 1–6.
Eifler-Bollen R, Fluhr JW. Antimikrobiell wirksame Magistralrezepturen. Stellenwert in der Praxis und kritische Anmerkungen. Hautarzt 2005; 56: 752–758.
Leclercq R, Bismuth R, Casin I, Cavallo JD, Croize J, Felten A, et al. In vitro activity of fusidic acid against streptococci isolated from skin and soft tissue infections. J Antimicrob Chemother 2000; 45: 27–29.
Mason BW, Howard AJ. Fusidic acid resistance in community isolates of methicillin susceptible Staphylococcus aureus and the use of topical fusidic acid: a retrospective case-control study. Int J Antimicrob Agents 2004; 23: 300–303.
Mason BW, Howard AJ, Magee JT. Fusidic acid resistance in community isolates of methicillin-susceptible Staphylococcus aureus and fusidic acid prescribing. J Antimicrob Chemother 2003; 51: 1033–1036.
Osterlund A, Kahlmeter G, Haeggman S, Olsson-Liljequist B. Staphylococcus aureus resistant to fusidic acid among Swedish children: a follow-up study. Scand J Infect Dis 2006; 38: 334–334.
Van Cutsem JM, Thienpont D. Miconazole, a broad-spectrum antimycotic agent with antibacterial activity. Chemotherapy 1972; 17: 392–404.
Kokjohn K, Bradley M, Griffiths B, Ghannoum M. Evaluation of in vitro activity of ciclopirox olamine, butenafine HCl and econazole nitrate against dermatophytes, yeasts and bacteria. Int J Dermatol 2003; 42: 11–17.
McLean KJ, Marshall KR, Richmond A, Hunter IS, Fowler K, Kieser T, et al. Azole antifungals are potent inhibitors of cytochrome P450 mono-oxygenases and bacterial growth in mycobacteria and streptomycetes. Microbiology 2002; 148: 2937–2949.
Raab WP. The interaction of corticosteroids and antimicrobial agents used in topical therapy. Br J Dermatol 1971; 84: 582–589.
Raab W, Gmeiner B. Interactions between econazole, a broad-spectrum antimicrobic substance, and topically active glucocorticoids. Dermatologica 1976; 153: 14–22.
Gentry DR, McCloskey L, Gwynn MN, Rittenhouse SF, Scangarella N, Shawar R, et al. Genetic characterization of Vga ABC proteins conferring reduced susceptibility to pleuromutilins in Staphylococcus aureus. Antimicrob Agents Chemother 2008; 52: 4507–4509.
Traczewski MM, Brown SD. Proposed MIC and disk diffusion microbiological cutoffs and spectrum of activity of retapamulin, a novel topical antimicrobial agent. Antimicrob Agents Chemother 2008; 52: 3863–3867.
Woodford N, Afzal-Shah M, Warner M, Livermore DM. In vitro activity of retapamulin against Staphylococcus aureus isolates resistant to fusidic acid and mupirocin. J Antimicrob Chemother 2008; 62: 766–768.
Sandström Falk MH, Särnhult T, Hedner T, Faergemann J. Treatment of atopic dermatitis with 1% hydrocortisone and 25% pentane-1,5-diol: effect on Staphylococcus aureus. Acta Derm Venereol 2006; 86: 372–373.
Faergemann J, Wahlstrand B, Hedner T, Johnsson J, Neubert RH, Nyström L, et al. Pentane-1,5-diol as a percutaneous absorption enhancer. Arch Dermatol Res 2005; 297: 261–265.
Faergemann J, Hedner T, Larsson P. The in vitro activity of pentane-1,5-diol against aerobic bacteria. A new antimicrobial agent for topical usage? Acta Derm Venereol 2005; 85: 203–205.
Karami N, Alsterholm M, Faergemann J. In vitro activity of chlorhexidine and pentane-1,5-diol and their combination on Candida albicans, Staphylococcus aureus and Propionibacterium acnes. Acta Derm Venereol 2009; 89: 514–515.
There are no related articles.
Share with your friends
There is no supplementary for this article.
Volume 90, Issue 3
View at PubMed