Comparative Efficacy of Topical Combination of Bacitracin and Neomycin vs. Chloramphenicol in the Treatment of Uncomplicated Mild to Moderate Surgical Skin and Soft Tissue Infections in Adult Out-patients

Clinical Microbiology and Antimicrobial Chemotherapy. 2013; 15(2):131-142

Type
Journal article

Objective.

To assess clinical efficacy and safety of topical combination of bacitracin and neomycin in comparison to topical chloramphenicol in the treatment of uncomplicated mild to moderate surgical skin and soft tissue infections (SSTI) in adult out-patients.

Materials and Methods.

A total of 309 adult patients with mild to moderate SSSTI were randomized to receive either topical powder and/or ointment of bacitracin+neomycin (n=156) or topical 0.75% chloramphenicol ointment (n=153) BID. Deep swabs were performed in all patients before the start of antibacterial therapy. Identification of pathogens and susceptibility testing were performed according to EUCAST guidelines, 2012.

Results.

The total cure rate was comparable in bacitracin + neomycin group and chloramphenicol group (97.4% for both regimens, p=0.98), but cure period was significantly shorter for bacitracin + neomycin regimen (cure rate by day 8 – 82.7% vs. 68.6%, р=0.004; by day 15 – 97.4% vs. 94.8%, respectively, р=0.23). The main causative agent of SSSTI was Staphylococcus aureus (82.5%), less frequently Streptococcus pyogenes (5.3%), Enterococcus faecalis (1.8%), Escherichia coli (1.3%), Streptococcus agalactiae (1.3%) and other (<1% each). 22% of S. aureus strains were resistant to chloramphenicol, 7.7% to tetracycline, 7.2% to macrolides, 3.3% to ciprofloxacin, 2.2% to clindamycin and gentamicin, 1.7% to oxacillin, mupirocin and chloramphenicol, 1.1% to fusidic acid and moxifloxacin, 0.6% to co-trimoxazole, while all isolated strains were susceptible to vancomycin and linezolid.

Conclusions.

Topical bacitracin+neomycin has high clinical efficacy in the treatment of uncomplicated mild to moderate surgical SSTI with significantly more rapid recovery in comparison to topical chloramphenicol and therefore can be recommended for the treatment of this group of infections in adult out-patients.

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