What are bacterial infections of the skin?
Skin infections are divided into primary and secondary.
Primary skin infections are those infections that are limited to a certain place and the surrounding tissues are not affected. In most cases, such infections are induced by bacteria Staphylococcus aureus and group A streptococci (Str. Pyogenes).
The most widespread infections are impetigo, folliculitis, cellulitis, and furunculosis.
Secondary skin infections
Secondary skin infections develop in cases where the skin at the site of localization of the infectious process has already been damaged. Examples include secondarily infected injured skin and dermatoses.
In 80-90% of cases, secondary infection is induced by streptococci and staphylococci that attack such injuries as cuts, scratches, burns, wounds (including post-operative). Secondarily infected dermatoses develop when a bacterial infection penetrates of an already existing pathological process, such as eczema. Damaged skin is the entrance gate to the pathogen, and subsequent invasion and proliferation of bacteria lead to the development of an infectious process. Most often, S. aureus and streptococci cause the development of secondarily infected dermatoses. It is believed that staphylococci are not only the main etiological cause of the development of eczema but also are the main reason for the frequent flare-ups of the disease and also worsen the course of the already existing pathological process.
Modern treatment of skin infections of mild and medium severity
Since the 60s, the use of antibiotics for oral administration has been the main focus of the treatment of skin infections of mild to moderate severity. In most countries, erythromycin, cephalexin, and fluloxacillin are the current drugs of choice. However, in developed countries newer antibiotics such as Zithromax (Azithromycin) can be used instead.
Although oral antibiotic therapy is effective most of the time, it has drawbacks. Antibiotics for oral use due to their systemic effect often cause side effects from the digestive tract part, such as diarrhea or nausea. An important factor for ensuring an effective level of the antibiotic in the body is its regular and frequent use. Any disturbance of the regimen of taking or dosages of the drug substantially affects its effectiveness. When using antibiotics for systemic use, allergic reactions can also develop so they must be used only according to the doctor's instructions and in the occurrence of rash, the use must be immediately discontinued.
Another disadvantage of treatment with oral antibiotics is the rapid development of drug resistance. For example, S. aureus resistance due to the use of lactam antibiotics is quite common. According to some reports, its level in the world reaches 90%. Only around ten years ago, S. aureus's sensitivity to erythromycin was 90%. The observation, in which the different skin infections were studied, showed that 51.5% of S. aureus strains found during in furunculosis are resistant to erythromycin, with impetigo this indicator reached 26.2%.
Some antibiotics for systemic use are used to treat hospital-acquired infections, which also leads to the development of resistance of pathogens to these medicines. Currently, many experts do not advise prescribing topical antibiotics that have a systemic effect. According to the literature, pathogen resistance develops due to the use of aminoglycosides, erythromycin, and clindamycin even for topical application.
Factors influencing the choice of treatment
The choice of local or oral antibiotic therapy is contingent on many factors, but the localization and severity of the infectious process are decisive factors. Local therapy is effective if the infectious process is superficial and localized. If the process reaches deeper skin structures or a large area is affected, antibiotics for oral administration can be used. If there are signs of a systemic infection, such as elevated body temperature, lymph nodes increase, or onset of streptococcal pharyngitis, it is preferable to prescribe antibiotics orally. In some cases, both local and systemic antibiotic therapy can be prescribed to a patient with widespread or severe skin infection.
The results of many clinical studies have not confirmed the suggestion that topical therapy is less effective than oral administration for mild and moderate infections. For example, it has been proved that for mild and moderate skin infections, mupirocin monotherapy (trade name BAKTROBAN) in the form of a cream or ointment is also effective and even in some cases exceeds the effectiveness of oral antibiotics. Medicines for local use are convenient to use, they are easier to dose than the medicines for oral administration. If it was possible to choose a treatment method, many people would prefer local therapy.
When conducting local therapy, the risk of developing systemic adverse reactions, including from the digestive tract, is minimal. When taken orally, an antibiotic acts on the microflora of the digestive tract, which often leads to the appearance of microorganism strains that are resistant to the action of the drug and colonize the digestive tract. Against the background of the use of certain antibiotics locally, for example, mupirocin, the resistance of pathogens develops very slowly, in contrast to antibiotics prescribed by mouth. Besides, a higher concentration of the medication, which is created at the site of localization of the infection, contributes to the eradication of a greater number of pathogenic microorganisms.
Requirements for local therapy infectious therapy
Topical antibacterial drugs should:
- Have the same efficacy as drugs intended for oral administration;
- Have good tolerance;
- Be active against all the main pathogens that cause skin infections of mild to moderate severity;
- Be available in dosage forms suitable for use in both primary and secondary skin infections.
Topical antibacterial drugs should not:
- Cause cross-resistance to other similar antibiotics that are used to treat severe systemic infections;
- Contain components that have a systemic effect.
Mupirocin, designed to treat skin infections of mild to moderate severity, is one of the medicines that meets these requirements. It has unique pharmacological properties that distinguish it from other antibiotics:
- Highly effective against both streptococci and staphylococci;
- Antibacterial activity is equivalent to that of oral antibiotics;
- Does not contain components that have a systemic effect;
- The chemical composition differs from other antibiotics; it is impossible to develop cross-resistance of microflora;
- Does not cause skin irritation; after 10 years of use worldwide, the resistance of pathogens to this medication is detected with a frequency of less than 1%. These factors, combined with good tolerance and safety, make it possible to consider the use of Mupirocin as a reliable alternative method for the local treatment of mild and moderate skin infections.
If topical agents do not work, you can buy a modern antibiotic Azithromycin. However, you should first consult a doctor especially if you have fever, increased lymph nodes, suffer from fatigue and general malaise.
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