The ABCs of Smart Antibiotic
By Janice Billingsley
(December 20, 2003 - HealthDayNews)
When most people get a prescription filled for antibiotics, the
last thing they're thinking about is how the medicine will get to
where it's supposed to work.
All they're thinking about is relief.
But the way an antibiotic is delivered is important, because it
can affect both the strength of the medicine as well as the risk
of side effects.
If your infection is on or near the surface of the skin, your doctor
will often prescribe a topical antibiotic, which means you apply
it directly to the infection. Conjunctivitis and vaginal yeast infections
are typical of such problems.
But most infections reside inside the body. So they require so-called
systemic antibiotics, which -- like pills or intravenous medicines
-- are taken internally and travel through the body to the infection
"There have been topical antibiotics for a long time, but
they have a limited number of uses," says Dr. David Calfee,
an epidemiologist at Mount Sinai Medical Center in New York City.
"The majority of infections require systemic antibiotics."
Still, topical antibiotics can be quite valuable, Calfee adds.
"Topical antibiotics have the advantage of delivering high
concentrations of medicine to a specific site," he says, while
systemic antibiotics have to be weaker to reduce the risk of side
effects to the whole body.
Another plus to topicals, says Calfee: Because they are targeted
against specific ailments, their use is less likely to lead to antibiotic
abuse or resistance.
Tuberculosis, gonorrhea, malaria and childhood ear infections are
just some of the health problems that have become increasingly resistant
to the antibiotics created to treat them. That's because bacteria
and other infection-causing germs are resilient and can develop
ways to survive drugs meant to destroy or weaken them, according
to the U.S. Food and Drug Administration.
Calfee says "topicals may reduce antibiotic resistance"
because many commonly used systemic antibiotics are designed to
fight a number of bacteria. And they're often prescribed without
knowing exactly which germ is causing the infection.
"They're used for superficial infections of the skin and ailments
like conjunctivitis and vaginal yeast infections," Calfee says.
"You have to be very comfortable that the infection is very
But doctors are finding new ways to deliver topical antibiotics
to more-difficult-to-reach areas of the body.
For instance, some physicians are using topically delivered antibiotics
in the deep nasal cavity for the treatment of severe sinusitis,
an inflammation of the sinuses, says Dr. Winston Vaughan, director
of Stanford University's Sinus Center.
In this method, a patient uses a machine called a nebulizer to
deliver an aerosolized version of medications -- including antibiotics
-- by breathing through the nose to target the lining of the sinuses.
The treatment takes about 20 minutes and is done two or three times
daily for three weeks, he says.
"Its use is very limited: for people who have failed with
oral or intravenous antibiotics," Vaughan says. But, he adds,
this system of delivery allows the drugs to get directly to the
Vaughan, who has published research on medications used with the
delivery system, says the technique has offered relief to some long-term
sinusitis sufferers who failed to find relief from oral or intravenous
Dr. Christopher Shaari, an otolaryngologist at Hackensack University
Medical Center in New Jersey, has also had success with this topical
delivery of antibiotics to treat severe sinusitis.
"I reserve this for those with chronic sinusitis who have not
responded to oral antibiotics," says Shaari, who has no connection
with the manufacturer.
"This delivery has fewer systemic side effects and will not
worsen underlying illnesses, like inflammatory bowel disease,"
he adds. "Also, you can administer a stronger dosage, and it's
relatively easy to do. There are no catheters or other IV [intravenous]
Still, Shaari says, this is an exceptional use of topical medicines.
"This is a unique mechanism for treating the mucosal cavity,"
he says, "but only when you've exhausted the oral treatments."
Topical antibiotics aren't for everyone or every ailment. But the
next time you're battling a bug, ask your doctor if they might be
an option for you.
SOURCES: David Calfee, M.D., assistant professor of medicine, hospital
epidemiologist, Mount Sinai Medical Center, New York City; Christopher
Shaari, M.D., otolaryngologist, Hackensack University Medical Center,
Hackensack, N.J.; Winston Vaughan, M.D. director, Stanford University
Sinus Center, Palo Alto, Calif.
(republished with permission of HealthDayNews)
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