13.10.1.1 Antibacterial preparations - use topically

Mupirocin

• Cream 2% (£5.26 = 15g)
• Ointment 2% (£16.03 = 15g)

Indications

• Proven MRSA

The use of topical antimicrobial agents has long been discouraged, on the grounds that it carries a particular risk of selecting resistance. However, some topical antibacterial use is strongly defensible, for example:

• Use of sulphonamides with silver nitrate to prevent and treat burn wound infections
• Use of mupirocin to eliminate colonisation and superficial infections caused by MRSA. Nevertheless, mupirocin can be misused e.g. by being given as blanket treatment or prophylaxis.

Silver sulfadiazine

• Cream 1% (£3.85 = 50g)

Indications

• Infected burns
• Leg ulcers

Dose

• Burns: Apply daily with a sterile applicator
• Leg ulcers: Apply at least 3 times weekly

13.10.1.2 Antibacterial preparations - also used systemically

Fusidic acid

• Cream 2% 15g, 30g (£2.35, £4.70)
• Ointment 2% 15g, 30g (£2.68, £4.55)

Indications and dose

• Non-bullous impetigo
  • Adults and children: Apply 3 times a day for 5–7 days

Metronidazole

• Gel 0.75% (click here for preferred brand)
• Cream 0.75% (£9.88 = 40g)

Indications

• Rosacea (mild to moderate)

Notes

1. Where a preferred brand is recommended for a particular presentation, prescribing by brand helps ensure cost-efficient use of local NHS resources (see preferred brand link above)