Dermatology
Topical antibiotics
Antibacterial creams and ointments (e.g. fusidic acid, mupirocin) — Antibacterial creams for small, localised skin infections — used sparingly to limit resistance.
Education and reference only. This is a plain-language class overview — it deliberately contains no doses. Always check the current Summary of Product Characteristics (SmPC), the BNF and your local formulary before prescribing or administering any medicine.
Quick answer
What is Topical antibiotics?
Topical antibiotics are creams and ointments that treat small areas of bacterial skin infection — such as impetigo or an infected patch of eczema — applied directly to the skin. They are used briefly and sparingly.
- How it works: They kill or stop the growth of bacteria on the surface of the skin where they are applied, clearing a localised infection.
- In practice: In practice topical antibiotics treat small, localised bacterial skin infections such as impetigo, infected eczema patches and minor infected wounds, applied directly to the area.
What it is
Topical antibiotics are creams and ointments that treat small areas of bacterial skin infection — such as impetigo or an infected patch of eczema — applied directly to the skin. They are used briefly and sparingly.
How it works
They kill or stop the growth of bacteria on the surface of the skin where they are applied, clearing a localised infection. Because bacteria readily become resistant when these drugs are overused, short, targeted courses matter to keep them working.
In practice
In practice topical antibiotics treat small, localised bacterial skin infections such as impetigo, infected eczema patches and minor infected wounds, applied directly to the area. The defining principle of modern use is stewardship: they are used in short courses for genuinely infected, limited areas, because widespread or prolonged use drives bacterial resistance (a particular concern with fusidic acid) and can cause contact allergy. Mupirocin is reserved in places to help preserve its activity against resistant bacteria such as MRSA. Extensive, spreading or systemic infection needs antibiotics taken by mouth rather than a cream. They are not the right choice for simple uninfected eczema, where emollients and steroids do the work. People are advised to wash hands, complete the short course, and stop and seek review if the infection spreads or fails to settle. Some preparations combine an antibiotic with a steroid for short-term use in infected inflammatory skin.
Examples
Practical use
How to take it & use it well
- Wash and dry the affected skin first, then apply a thin layer to the infected area and a little beyond its edge, using clean hands or a clean cotton bud.
- Wash your hands before and after applying, and avoid sharing towels or flannels, as skin infections such as impetigo spread easily to others and to other parts of your body.
- Use it for the full short course you have been given and no longer, as using these antibiotics for too long encourages bacteria to become resistant to them.
- Keep it away from the eyes unless you have an eye preparation specifically for that purpose, and do not use leftover skin antibiotics on unrelated problems.
- If the infection is spreading, weeping heavily, or you feel unwell with a fever, see your GP, as you may need an antibiotic taken by mouth instead.
- Cover the area lightly if advised, especially in children, to stop them touching it and spreading the infection further.
Common uses
- Impetigo and small infected skin areas
- Infected eczema patches (short course, often with a steroid)
- Nasal decolonisation in some settings (mupirocin)
Monitoring
- Resolution of the localised infection
- Spread or failure to settle (needs review/oral treatment)
- Skin irritation or contact allergy
Weighing it up
Advantages & disadvantages
Advantages
- They treat minor, localised skin infections directly at the site, with very little absorbed into the body.
- They are simple to apply at home and act quickly on small infections such as mild impetigo or infected cuts.
- Side effects are usually limited to the skin and are generally mild.
- They help avoid the need for antibiotics taken by mouth for small, contained infections.
- One of them is also used inside the nose to clear bacteria that can cause repeated infections, under medical advice.
Disadvantages
- Overusing them encourages resistance, so they are kept for short courses and small areas.
- They are not suitable for large, deep or spreading infections, which need treatment taken by mouth.
- They can occasionally cause stinging, redness or an allergic skin reaction where applied.
- Using them on unconfirmed or non-bacterial skin problems can delay the right treatment.
- Repeated use of the same skin antibiotic can make it less effective over time.
Key safety principles
What to watch for
- Use short, targeted courses — overuse drives resistance (notably with fusidic acid) and can cause contact allergy.
- Extensive, spreading or systemic infection needs oral antibiotics, not a cream.
- Not for uninfected eczema (use emollients/steroids); some products combine an antibiotic with a steroid for short-term use.
Key interactions
What to avoid or check alongside
- Because very little is absorbed, interactions with medicines taken by mouth are uncommon, but always tell your pharmacist what else you use.
- Applying other creams or cosmetics to the same area at the same time can reduce contact and effectiveness.
- Using a skin antibiotic repeatedly or for too long can breed resistant bacteria that no longer respond to it.
- Combining it with the same antibiotic taken by mouth should only be done on medical advice to avoid overuse.
- Using it on broken or weeping skin without cleaning first can trap bacteria and slow healing.
Patient & carer advice
- Apply only to the affected area for the short course you are given
- Wash your hands before and after, and do not share towels
- See us if the infection spreads, worsens or has not cleared by the end of the course
Answers
Topical antibiotics: frequently asked questions
How long should I use an antibiotic cream for impetigo?
Use it for the short course you have been given and no longer, as overusing these antibiotics breeds resistance. If the infection is spreading or not improving within the course, see your GP, as you may need an antibiotic taken by mouth.
Can I use leftover antibiotic cream on a different spot?
It is best not to, as the new problem may not be a bacterial infection, and using these antibiotics unnecessarily encourages resistance. Get unfamiliar skin problems checked rather than reaching for old creams.
Is impetigo contagious while I'm treating it?
Yes, impetigo spreads easily through touch and shared towels until it has been treated and the sores have crusted or healed. Wash your hands often, avoid sharing flannels and towels, and keep children off school until advised it is safe.
When do I need tablets instead of a cream?
If the infection is large, deep, spreading, or you feel unwell with a fever, a cream alone is not enough and you will likely need an antibiotic taken by mouth. See your GP, who can decide which is appropriate.
Why has my doctor given me an ointment for inside my nose?
Some people carry bacteria inside the nose that cause repeated skin infections, and a nasal antibiotic ointment can help clear them. This is used under medical advice for a short course rather than long-term.
Authoritative sources
Always verify against the source
This overview is for orientation. For doses, interactions, contra-indications and the full monograph, use:
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