What topical antibiotic cream is recommended for a 45-year-old patient with a persistent open lesion under a skin fold, who has shown improvement after 10 days of Bactrim (trimethoprim/sulfamethoxazole) therapy?

From the Research

For an open lesion under a skin fold that hasn't fully healed after 10 days of Bactrim, I recommend switching to mupirocin 2% ointment (Bactroban) applied three times daily for 7-10 days. This topical antibiotic is effective against common skin bacteria including Staphylococcus aureus and Streptococcus species that often colonize moist skin fold areas 1. Keep the area clean and dry between applications, gently cleansing with mild soap and water before each application. Consider using a moisture-wicking barrier like zinc oxide or a thin cotton dressing to prevent maceration from skin fold moisture. Some studies suggest that topical antibiotic ointments may not be necessary for clean surgical wounds and may increase the risk of allergic contact dermatitis and antibiotic resistance 2. However, for an open lesion under a skin fold, the risk of infection is higher, and topical antibiotics may be beneficial in preventing infection and promoting healing 3, 4. If the lesion shows signs of worsening infection (increasing redness, warmth, pain, or drainage) despite this treatment, the patient should be reevaluated as they may need oral antibiotics with different coverage or wound culture to identify specific pathogens. Mupirocin works by inhibiting bacterial protein synthesis and is particularly useful for localized skin infections where targeted topical therapy is appropriate. It's also important to note that intertrigo, a common condition in skin folds, can be prevented and managed with proper skin care and moisture management 1. In terms of specific topical antibiotic ointments, a study found that a triple-antibiotic ointment (polymyxin B-bacitracin-neomycin) was superior to simple gauze-type dressing alone in minimizing scarring in dermabrasion wounds 5. However, the most recent and highest quality study 2 suggests that mupirocin 2% ointment may be a better option for localized skin infections. Key points to consider when treating an open lesion under a skin fold include:

• Keeping the area clean and dry
• Using a moisture-wicking barrier to prevent maceration
• Applying topical antibiotics as needed to prevent infection
• Monitoring for signs of worsening infection and adjusting treatment as necessary
• Considering the use of mupirocin 2% ointment for localized skin infections.