Bacterial skin infections represent some of the most common infectious diseases globally. Prevention and treatment of skin infections can involve application of a topical antimicrobial, which may be an antibiotic (such as mupirocin or fusidic acid) or an antiseptic (such as chlorhexidine or alcohol). However, there is limited evidence to support the widespread prophylactic or therapeutic use of topical agents. Challenges involved in the use of topical antimicrobials include increasing rates of bacterial resistance, local hypersensitivity reactions (particularly to older agents, such as bacitracin), and concerns about the indiscriminate use of antiseptics potentially coselecting for antibiotic resistance. We review the evidence for the major clinical uses of topical antibiotics and antiseptics. In addition, we review the mechanisms of action of common topical agents and define the clinical and molecular epidemiology of antimicrobial resistance in these agents. Moreover, we review the potential use of newer and emerging agents, such as retapamulin and ebselen, and discuss the role of antiseptic agents in preventing bacterial skin infections. A comprehensive understanding of the clinical efficacy and drivers of resistance to topical agents will inform the optimal use of these agents to preserve their activity in the future.

中文翻译：

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当前和新兴的局部抗菌剂和防腐剂：药剂，作用和耐药模式[评论]

细菌性皮肤感染是全球最常见的一些传染病。皮肤感染的预防和治疗可涉及局部使用抗生素，该抗生素可以是抗生素（例如莫匹罗星或夫西地酸）或防腐剂（例如洗必泰或酒精）。然而，仅有有限的证据支持局部药物的广泛预防或治疗用途。使用局部抗微生物剂涉及的挑战包括细菌耐药率增加，局部超敏反应（尤其是对老年药物，如杆菌肽），以及不加选择地使用可能共同选择抗生素耐药性的抗菌剂的问题。我们审查了局部抗生素和防腐剂的主要临床用途的证据。此外，我们回顾了常见的局部用药的作用机理，并定义了这些用药中抗药性的临床和分子流行病学。此外，我们审查了潜在的使用新的和新兴的药物，如retapamulin和ebselen，并讨论了防腐剂在预防细菌性皮肤感染中的作用。对临床疗效和对局部用药耐药的驱动因素的全面理解将为这些药物的最佳使用提供信息，以在将来保持其活性。