Italians abuse antibiotic creams. According to the latest AIFA report, the consumption of the top 10 non-systemic antibiotics for dermatological use is equal to over 278 million doses per year, of which over 168 million concern gentamicin, also associated with cortisone, among the most used antibiotic creams also for DIY. Warning about the risks of the abnormal use of antibiotic creams is a pool of expert dermatologists, 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, i.e. substances capable of combating the microorganisms present on the skin surface and stopping their multiplication through a broad-spectrum action.
“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 minor wounds and burns are contaminated by a multiplicity of microorganisms refractory to the specific action of the antibiotic, but it also reduced by a third the sensitivity to the most commonly used antibiotics such as, for example, gentamicin – explains Giuseppe Argenziano, president of Sidemast and director of the Dermatology Clinic of the University of Campania “Luigi Vanvitelli” in 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, he continues, “gentamicin, commonly used in the treatment of superficial skin infections, was found to be correlated with an important emergence of bacterial resistance. An evaluation of data from the Antimicrobical Resistance Surveillance Network, collected from 105 hospitals, in which analyzed over 148 thousand isolated samples of Staphylococcus aureus in patients with skin infections, found a high bacterial resistance to gentamicin, with sensitivity to the drug only in 98 strains out of 299″. the price paid for too many prescriptions of antibiotic creams by specialists, even for superficial infections”, warns Giuseppe Micali, director of the Dermatology Clinic of the University of Catania, one of the experts in the policy document and author of a study conducted out of 1,500 specialists.
According to the experts, the first guidance document recommends the use of antiseptics for minor wounds and burns
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”.
“In accordance with the most recent scientific evidence, to prevent infections of small traumatic and post-surgical wounds, mild burns and ulcerative lesions, without fueling the phenomenon of antibiotic resistance, the guideline document underlines the need to resort to The exclusive use of antiseptics, in the form of creams, gauzes or plasters – explains Maria Rita Nasca, one of the co-authors of the document and dermatologist of the Dermatology Clinic of the University of Catania – The use of topical antibiotics, today, must instead be limited to specific circumstances, such as, for example, the onset of evident signs of local or systemic infection, such as feverish states, or in the presence of immunosuppressed patients or patients with diabetes”.
“We have several effective and broad-spectrum antiseptics available that act quickly at low concentrations, such as chlorhexidine, but first of all the wheat extract with polyhexanide which, in addition to being particularly capable of reducing the risk of infections without exposing danger of bacterial resistance, have demonstrated high effectiveness in promoting wound repair”, adds Pietro Rubegni, full professor of Dermatology and director of the Department of Dermatology of the University of Siena, one of the co-authors of the expert opinion “Per Italy therefore needs greater awareness to avoid the indiscriminate use of antibiotics in the dermatological field, which encourages their 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.
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