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The end of the line for antibiotic creams

June 7, 2017

Those who have travelled overseas often lament that some medicinal drugs, such as antibiotic creams, are very tightly regulated in New Zealand, and yet in countries like Mexico or Thailand, it is often possible to purchase such drugs without a prescription. Whilst this may cause frustration to consumers the reasoning behind the restrictions in New Zealand is sound.

In the Halcion days of the 1990s it was possible to buy Bactroban Cream (mupirocin) over the counter in New Zealand, and everyone loved easy access to antibiotic cream and got in the habit of using it as a first aid cream to dab on any number of wounds. Unfortunately, the excessive use led to an increase in rates of resistance to skin bacteria such as Staphylococcus aureus, which hit 28% in 1999. The cream became prescription only in a bid to curb usage.

Unfortunately, we did not learn from our mistakes. In the 2000s prescribing of Foban (fusidic acid cream) rocketed, along with resistance rates of Staphylococcus aureus to it. Nowadays, microbiologists have been known to dryly comment that the use of antibiotic creams is probably no more effective than Vaseline in treating skin infections because of the high resistance rates.

Staphylococcus aureus causes many skin infections including impetigo and infected eczema. There is huge concern worldwide about antimicrobial resistance, which has been driven by excessive use of topical antibiotics (antibiotic creams rather than tablets). Staphylococcus aureus is described as a superbug when it has developed resistance to multiple antibiotics. Unfortunately, those who have had surgery and get infected by superbugs are very hard to treat, and outcomes are not good.

Since 2014 GPs in New Zealand have been informed of the risks of antibiotic resistance developing from excessive prescription of topical antibiotics, however over 265 000 prescriptions were still issued in the year ending June 2016. It is time for change.

The GPs at Medplus have been discussing use of antibiotic creams in their educational meetings and are striving to significantly reduce their prescribing of them. There are now very few indications to prescribe topical antibiotics. Nowadays we are far more likely to recommend an antiseptic cream such as hydrogen peroxide cream or povidone – iodine ointment and good skin hygiene. If we are concerned about a significant infection, we are likely to prescribe an oral antibiotic rather than a cream.

The practice of keeping tubes of antibiotic creams to use as first aid for the household is strongly discouraged, throw them away! Please work with us to preserve our existing antibiotics to use for those who really need them, it may end up being you.