From the Guidelines
If nystatin-triamcinolone cream hasn't resolved a likely bacterial skin infection, mupirocin 2% ointment (Bactroban) would be an appropriate alternative. Apply a thin layer to the affected area three times daily for 7-10 days. Mupirocin is effective against common skin bacteria including Staphylococcus aureus and Streptococcus species, as supported by the guidelines for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children 1. It works by inhibiting bacterial protein synthesis and is particularly useful for localized infections. For more widespread or severe infections, consider oral antibiotics like cephalexin 500mg four times daily for 7-10 days instead.
Some key points to consider when using mupirocin 2% ointment include:
- It is effective for minor skin infections, such as impetigo, and secondarily infected skin lesions, like eczema or ulcers 1
- Incision and drainage may be necessary for cutaneous abscesses, and antibiotics may provide additional benefit in certain cases 1
- Mupirocin 2% ointment is a suitable option for patients who have not responded to nystatin-triamcinolone cream, as it targets bacterial infections, whereas nystatin-triamcinolone is primarily effective against fungal infections with an anti-inflammatory component 1
It's essential to keep the affected area clean and dry during treatment, and if symptoms worsen or don't improve within 2-3 days of starting the new medication, seek medical attention as culture and sensitivity testing may be needed. The guidelines recommend considering the local epidemiology and the type of skin and soft-tissue infection when selecting an antibiotic, and mupirocin 2% ointment is a reasonable choice for localized bacterial skin infections 1.
From the Research
Alternative Antibiotic Creams
If Nystatin-Triamcinolone did not work for a likely bacterial skin infection, other antibiotic creams can be considered. Some options include:
- Mupirocin 2, 3
- Fusidic acid 2, 3
- Bacitracin 3
- Neomycin 3
- Polymyxin B 3, 4
- Nitrofurazone 3, 4
- Retapamulin 2
Considerations for Treatment
When choosing an alternative antibiotic cream, it's essential to consider the severity of the infection, the patient's medical history, and the potential for antibiotic resistance 2, 5, 6. The treatment response may be affected by factors such as the type of pathogen, antibiotic susceptibility patterns, and the use of systemic or non-systemic antibiotics 6.