CREMONA – The excessive use of local antibiotics in the dermatological field is demonstrated by consumption data: according to the latest report released by AIFA on the use of antibiotics in Italy, the consumption of the top 10 non-systemic antibiotics for dermatological use is equal to over 278 million doses per yearof which further 168 million concern the consumption of gentamicin alone, also associated with cortisone, among the most abused antibiotic creams also for do-it-yourself. A new emergency, already highlighted by the WHO in the 2021 AWaRe manual to reduce the prescription of topical antibiotics, which also fits into Italy in theunresolved emergency of antibiotic resistance.
A pool of expert dermatologists is warning about the risks of the abnormal use of antibiotic creams who worked on the first policy document on the correct use of antibiotics to reduce the probability of the onset of antibiotic resistance in dermatology. At the center of the experts’ recommendations is the use of antiseptics, instead of local antibiotics, that is, substances capable of counteracting the microorganisms present on the skin surface and stopping their multiplication through a broad-spectrum action.
INEFFECTIVE TREATMENTS AND INCREASE IN RESISTANT SKIN INFECTIONS
“The massive and improper use of local antibiotic therapy even for superficial skin infections, which affect millions of Italians every year, is in fact not only ineffective, because wounds and minor burns are contaminated by a multiplicity of microorganisms refractory to the specific action of the antibioticbut it also reduced by a third the sensitivity to the most commonly used antibiotics such as, for example, gentamicin – he explains Giuseppe Argenziano, president of SIDeMaST and director of the Dermatology Clinic of the University of Campania “Luigi Vanvitelli” of Naples -. Recent studies on strains of Staphylococcus aureus, the bacterium involved in approximately 40% of cases of bacterial skin infections, have shown an increasing rate of resistance to the most used topical antibiotics. In particular, gentamicin, commonly used in the treatment of superficial skin infections, was linked to an important emergence of bacterial resistance. An evaluation of data from the Antimicrobical Resistance Surveillance Network, collected from 105 hospitals, in which over 148 thousand isolated samples of Staphylococcus aureus were analyzed in patients with skin infections, found a high bacterial resistance to gentamicin, with a sensitivity to the drug only in 98 strains out of 299”.
ALSO EFFECTS ON RESISTANCE TO ORAL ANTIBIOTICS, NO TO DO-IT-YOURSELF
“Improper use of topical antibiotics can also affect the increase in bacterial resistance to systemic antibiotics – he warns Stefano Veraldi, professor of Dermatology and Venereology at the University of Milan Bicocca -. For example, treating acne incorrectly can not only worsen the pathology itself, but also lead to the onset of important problems, such as systemic antibiotic resistance, which can also represent a danger for future therapies. The do-it-yourself use of topical antibiotics is therefore a mistake that can intensify in the summer, during the holidays, which lead to a more active and outdoor life, often less protected by clothes, in which it can happen of suffering insect bites, small wounds such as cuts, traumatic injuries or mild burns caused by exposure to the sun, which can be superinfected by microorganisms, – underlines Veraldi -. Even in these cases, empirical, do-it-yourself antibiotic coverage should be avoided”.
7 OUT OF 10 SPECIALISTS DO NOT USE ANTISEPTICS FOR SMALL SURGICAL WOUNDS
“The increase in topical antibiotic resistance in skin infections is the price paid for too many antibiotic cream prescriptions by specialists, even for superficial infections”, he declares Giuseppe Micali, director of the Dermatology Clinic of the University of Catania, among the experts of the policy document and author of a study conducted on 1500 specialists. Dermatologists, plastic surgeons and aesthetic doctors were invited to respond to a questionnaire that collected data at a national level to analyze the topical treatment chosen to prevent infections of small surgical wounds following laser therapy, superficial peels, biopsies or cryotherapy. From the responses collected, it emerged that approximately 7 out of 10 specialists routinely use topical antibiotics and only 20% prescribe hydrating and re-epithelizing treatments. “The reason for this choice depends on the mistaken belief that this therapeutic conduct can be useful in preventing superficial infections – states the expert -. The investigation conducted in the field therefore confirmed the bad habit of a good part of the categories examined in prescribing topical antibiotics for the dressing of small surgical wounds. All this in contrast with the current international and national guidelines which provide for the exclusive use, both in the pre-operative and post-operative phase, of antiseptic agents which do not influence the refractoriness of bacterial microorganisms, limiting the use of topical antibiotic therapy only to specific conditions”.
THE ADDRESS DOCUMENT
“In accordance with the most recent scientific evidence, to prevent infections of small traumatic and post-surgical wounds, minor burns and ulcerative lesions, without fueling the phenomenon of antibiotic resistance, the policy document highlights the need to appeal to the exclusive use of antiseptics, in the form of creams, gauzes or plasters – explains Maria Rita Nasca, among the co-authors of the document and dermatologist at the Dermatology Clinic of the University of Catania -. The use of topical antibiotics must, however, today be limited to specific circumstances, such as, for example, the onset of obvious signs of local or systemic infection, such as feverish states, or in the presence of immunosuppressed patients or with diabetes”.
“We have several available effective antiseptics and broad-spectrum that act quickly at low concentrations, such as chlorhexidine, but first and foremost wheat extract with polyhexanide which, in addition to being particularly capable of reducing the risk of infections without exposing us to the danger of bacterial resistance, have demonstrated high effectiveness in promoting wound repair”, adds Pietro Rubegni, full professor of Dermatology and director at the Department of Dermatology of the University of Siena, among the co-authors of the expert opinion.
For the treatment of impetigo, folliculitis and acne, however, the use of antiseptics is only indicated for some patients and in specific situations. “Impetigo is a highly infectious and extremely itchy bacterial skin infection, common in children under 10 years of age, but can also affect adults,” he says. Marco Ardigò, professor of Dermatology at Humanitas University of Milan and head of Oncological Dermatology at IRCCS Istituto Clinico Humanitas -. The use of detergents and antiseptics, such as those based on polyhexanide, is often useful to avoid relapses, but only if the pathological manifestation is not extensive”.
Folliculitis, on the other hand, is an infection of the hair follicles, generally itchy, but also painful. It represents a very common condition that often involves localized sites such as the face and limbs. “The treatment of folliculitis is based on topical antibiotics with the use of systemic therapies – adds Ardigò -, but in specific cases, such as in the presence of follicular inflammatory processes, antiseptics are used instead. For acne, however, antiseptic therapy is indicated as a support for antibiotic treatment possibly prescribed by the specialist”.
“Therefore, Italy now needs greater awareness in order to avoid the indiscriminate use of antibiotics in the dermatological field, which encourages limited use. Our approach to clinical practice must change, with an increasingly frequent use of antiseptic substances instead of antibiotics. Otherwise we will find ourselves faced with an emergency in the treatment of skin infections”, concludes Argenziano.
