In today’s post, I will review over the counter antibiotic creams in the UK. Some over the counter creams, gels and ointments available in the UK, have an ‘antibiotic’ properties however most of them are not genuinely classified as antibiotics, due to their limitations in terms of elimination of infections. The main focus of this post is to review use and the effectiveness of ‘antibiotic’ creams, supported any existing evidence. I will include different formulations not only creams as this broadens your choice and discussion. I will also talk about private services offered by online pharmacies to buy antibiotic creams. Over the counter antibiotic cream -summary of the post:
- Can you buy over the counter antibiotic cream?
- Antibiotic versus antiseptic cream: what is the difference?
- Signs and symptoms of bacterial skin infection
- Over the counter antibiotic creams (review)
- Can I use steroid cream to treat skin infection?
- Prescription-only antibiotic creams
Can you buy over the counter antibiotic cream?
Except for chloramphenicol eye ointment for conjunctivitis, antibiotic creams cannot be purchased over the counter in the UK. Antibiotic creams are prescription-only medicines. A doctor or another qualified prescribed needs to issue NHS or private prescription for supply to happen.
Buy antibiotic cream online – private services
Different online pharmacies offer a private service allowing customers to buy a prescription-only antibiotic cream. Patients are usually required to complete an online assessment, which is reviewed by a doctor who issues the prescription with the product delivered to the patient. Consultation fee is generally included in the price of antibiotic cream; however, this may vary between each pharmacy.
Antibiotic versus antiseptic cream: what is the difference?
Antiseptic creams are preparations which are applied to the skin to reduce the possibility of infections or to slow the growth of bacteria. Antiseptic creams are not absorbed into the skin a lot. Antiseptic creams have bacteriostatic properties (stops bacteria from multiplying) as opposed to antibiotic creams, which are bactericidal (kill the bacteria).
Antibiotics creams are absorbed into the body to kill off the bacteria and prevent a bacterial infection from spreading (Nankervis H, Thomas KS, Delamere FM, et al., 2016).
In reality, however, there is no clear cut between both types of drugs. Some antiseptic/bacteriostatic products can kill bacteria, however not in sufficient amounts as compared to antibiotics, which eliminate an infection. (Pankey & Sabath, 2004).
Most over the counter ‘antibiotic’ creams in the UK are in fact bacteriostatic and therefore differ from prescription-only antibiotic creams.
Signs and symptoms of bacterial skin infection
The main symptoms associated with skin infections include:
- Red, hot skin at the site of infection
- Pus coming out of the injury
- Presence of crust or blisters
- Pain and swelling
Patients should see their GP if the above symptoms are getting worse or if the infection spreads quickly. The most appropriate treatment in this situation would be prescription-only antibiotic cream or oral antibiotic.
Over the counter antibiotic creams
1. Hydrogen peroxide over the counter antibiotic cream
Hydrogen peroxide is best known as a liquid preparation, which is usually used as a skin disinfectant and as a mouthwash. Hydrogen peroxide also comes in the form of a cream, known as Crystacide.
What is hydrogen peroxide cream used for?
Crystacide cream is licensed for the treatment of skin infections caused by a microorganism, which are sensitive to hydrogen peroxide. Therapy with this cream is usually limited to three weeks.
Where can you buy hydrogen peroxide cream?
Hydrogen peroxide cream (brand name: Crystacide) is a pharmacy-only medication, which means it can only be purchased from registered pharmacies, including online chemists.
Crystacide cream is rarely prescribed in a community. It is unlikely for most pharmacies to stock this cream. Patients can ask a pharmacy team to order Crystacide cream on an individual basis for the same or next day delivery, as Crystacide cream is stock by the leading pharmaceutical wholesalers in the UK.
Is hydrogen peroxide cream effective over the counter antibiotic cream?
Hydrogen peroxide has powerful antimicrobial properties (stop the growth of the bacteria) against various type of bacteria (McDonnellm 2014), including gram-positive as well as gram-negative bacteria. In the lab test, hydrogen peroxide cream had similar effectiveness to hydrogen peroxide liquid with a longer duration of action.
However, hydrogen peroxide is classified as antiseptic rather than an antibiotic product.
Use of hydrogen peroxide cream for the treatment of infections
A doctor can prescribe hydrogen peroxide cream (Crystacide). Currently, hydrogen peroxide cream is one treatment option for localised impetigo, in patients who are well, and there is no risk of complications. As the evidence shows hydrogen peroxide 1% cream can be effective as skin antibiotic for the treatment of impetigo (NICE, 2020).
2. Brulidine – over the counter antibiotic and antiseptic cream
Brulidine is advertised as antiseptic and antibacterial cream, which is recommended for the management of different skin conditions including nappy rash, superficial bacterial and fungal infections including scalp ringworm. Additionally, as advertised, it may help with the healing of cuts, grazes, wounds.
The main active ingredient found in Brulidine cream is dibrompropamidine isethionate (0.15%).
Dibrompropamidine isethionate is an active ingredient included in a couple of products available over the counter, one of which is Brulidine cream. The other, Golden Eye Ointment is a pharmacy-only medicine which contains dibrompropamidine. Golden Eye Ointment is licensed for the treatment of different eye conditions including conjunctivitis, blepharitis (inflammation of the eyelids) and sties.
Is Brulidine the best over the counter antibiotics cream?
Little evidence exists to support the effectiveness of Brulidine as an antibiotic cream. Product information for dibrompropamidine isetionate classify this ingredient as bacteriostatic (stops bacteria from multiplying) and antiseptic. Dibrompropamidine isetionate is active against gram-positive bacteria (for example Staphylococcus), but less active against gram-negative bacteria. Staphylococcus (a type of bacteria) commonly cause skin infections.
Dibrompropamidine isethionate may also have antifungal properties.
Where to get Brulidine cream over the counter?
Pharmacies do not commonly stock Brulidine cream. Some pharmacies may sell Brulidine cream off their planogram. Some pharmacies can order Brulidine cream from leading pharmaceutical suppliers for the same or next day delivery in the pharmacy.
Brulidine cream can be purchased online, from many websites, including Amazon.co.uk (see link below).
3. Daktacort cream
Daktacort cream is mostly known as an antifungal cream, used in the management of various fungal skin infections, for example, athlete’s foot and sweat rash, and other conditions such as eczema (dry, irritated skin) and dermatitis (a type of eczema).
Daktacort contains two active ingredients, an antifungal drug (miconazole) and a mild steroid (hydrocortisone). Addition of steroid in the formulation helps to manage the symptoms of redness, itchiness and inflammation.
Product license for Daktacort includes treatment of many gram-positive bacteria, including most strains of Streptococcus and Staphylococcus.
Daktacort can be used by adults and children over ten years of age with a maximum duration of 7 days of the treatment unless advised otherwise by a doctor. For more details about the restrictions on the use of Daktacort, read the product information leaflet.
Is Daktacort an effective antibacterial cream?
When tested in the lab (in vitro), miconazole was found to be effective against various of gram-positive bacteria, with suggested treatment option in skin infection caused by this group of bacteria (Nenoff et al., 2017).
Where to buy Daktacort cream from?
Dactacort cream is a pharmacy-only medication (P). P products can only be sold from pharmacies, including online chemists.
4. Dermol cream and lotion
Dermol cream and lotion are used for the management of dry and itchy skin caused by eczema and dermatitis. Dermo; products are classified as antimicrobial agents (not an antibiotic). Addition of two antiseptics in the formulation of help to reduce the chances of skin infections, which is possible in eczema for example, due to scratching. Dermol lotion is commonly used as a soap substitute.
Dermol lotion and cream – active ingredients
The most common formulations Dermol lotion (Dermol 500) and Dermol cream contain the following active ingredients:
- Liquid paraffin
- Isopropyl myristate
- Benzalkonium chloride
- Chlorhexidine dihydrochloride
Is Dermol effective over the counter antibiotic?
Dermol cream and lotion contain two antiseptic agents – benzalkonium chloride and chlorhexidine dihydrochloride. Both benzalkonium and chlorhexidine are used in a variety of pharmaceutical products due to their antimicrobial activities. Both are commonly used as preservatives and antiseptics to minimise the growth of bacteria in different pharmaceutical products, for example, eye drops and ointments, throat lozenges and sprays, antiseptic skin products.
As antiseptic (stop the growth of bacteria), benzalkonium chloride and chlorhexidine are effective against a wide range of gram-positive and gram-negative bacteria (Bednarek et al., 2020).
Where to buy Dermol range from?
Dermol range, including Dermol lotion and cream, are pharmacy-only products. Most pharmacies stock Dermol products, which are usually kept in the dispensary and not on public display. One needs to speak to a member of a pharmacy team to purchase Dermol product (s). Many online chemists also stock Dermol products.
5. Chloramphenicol eye ointment
I decided to include chloramphenicol eye ointment in this review, although over the counter chloramphenicol is licensed for the treatment of conjunctivitis, an eye infection.
Chloramphenicol comes in the form of eye drops and eye ointment. Both products are pharmacy-only medicines and thus available only from chemists.
Out of all reviewed products, chloramphenicol is the only medicine, which is classified as an antibiotic. When used in the treatment of conjunctivitis, chloramphenicol is safe, effective, and cheap (BMJ, 2006).
As with other drugs, it is possible to use medicines outside their license, under a recommendation by a doctor who usually issues a prescription. Chloramphenicol is a potent broad-spectrum antibiotic, meaning it is effective against a range of bacteria. With this, chloramphenicol is sometimes used outside its licence when prescribed by a doctor. For example, chloramphenicol may be applied after facial surgery to wounds on face, to prevent infections (NHS Wirral, 2015).
One study investigated the use of chloramphenicol ointment as a post-operative measure to reduce skin infection (single dose). It was found that the incidence of infections in a group of patients who used chloramphenicol was lower to a group of patients who used unmedicated ointment. The reduction of skin infection was statistically significant but not clinically relevant (BMJ, 2009).
Another common unlicensed use of chloramphenicol eye ointment is a post-circumcision application to reduce the chances of infection. Chloramphenicol is also used to treat skin infections in cats and dogs.
Can you use steroid cream to treat skin infection?
Steroid creams are useful in the management of skin conditions characterised by redness, inflammation, itchiness, for example, eczema and dermatitis. Two different steroid creams can be purchased without a prescription: hydrocortisone and clobetasone, which is the strongest over the counter steroid cream.
Steroid creams on their own should not be applied on infected skin (viral, bacterial, or fungal infections) unless advised by a doctor. Some prescription-only antibiotics come as a combination of antibiotic and steroid, and these can be used to treat skin infections when prescribed by a doctor.
Prescription-only antibiotic creams
Selection of most appropriate medication for bacterial skin infections is based on the severity of symptoms present, any local information on antibiotic resistance (if a particular antibiotic does not work) and results from microbiological results (NICE BNF, 2020).
Typical skin products used in the treatment of skin infections include:
- Hydrogen peroxide 1% cream
- Fusidic acid cream
- Mupirocin cream or ointment
- Oral antibiotics with flucloxacillin most commonly prescribed
I reviewed a number of over the counter antibiotic creams, which are available in the UK. Although advertised as antibiotic creams, some products are simply antiseptic, with not enough evidence to support their effectiveness as antibiotic agents.
Out of all reviewed products, hydrogen peroxide cream (Crystacide) have the best evidence to support its use as an antibiotic cream, which can be purchased over the counter. Daktacort (a combination of miconazole and hydocortisone) is licensed for the treatment of infections caused by gram-positive bacteria, alongside other fungal infections. The license use of Daktacor cream give reassurance in therms of its effectiveness as over the counter antibacrial cream. Chloramphenicol eye ointment is a potent and effective antibiotic; however, its over the counter license limits the use for the treatment of skin infections.
Bednarek RS, Nassereddin A, Ramsey ML. Skin Antiseptics. (Updated 2020 Jun 3). In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available at: https://www.ncbi.nlm.nih.gov/books/NBK507853/ Accessed on 01/12/2020
BMJ (2006). A randomised controlled trial of management strategies for acute infective conjunctivitis in general practice. Available at: https://doi.org/10.1136/bmj.38891.551088.7C Accessed on 01/12/2020
BMJ (2009). Does single application of topical chloramphenicol to high risk sutured wounds reduce incidence of wound infection after minor surgery? Prospective randomised placebo controlled double blind trial. Available at: https://doi.org/10.1136/bmj.a2812 Accessed on 01/12/2020
McDonnell, G. (2014). The Use of Hydrogen Peroxide for Disinfection and Sterilisation Applications. Available at: https://doi.org/10.1002/9780470682531.pat0885 Accessed on 30/11/2020
Nankervis H, Thomas KS, Delamere FM, et al. Scoping systematic review of treatments for eczema. Southampton (UK): NIHR Journals Library; 2016 May. (Programme Grants for Applied Research, No. 4.7.) Chapter 6, Antimicrobials including antibiotics, antiseptics and antifungal agents. Available from: https://www.ncbi.nlm.nih.gov/books/NBK363143/ Accessed on 28/11/2020
Nenoff P, Koch D, Krüger C, Drechsel C, Mayser P., (2017). New insights on the antibacterial efficacy of miconazole in vitro. Mycoses. 2017 Aug;60(8):552-557. doi: 10.1111/myc.12620. Epub 2017 Mar 30. PMID: 28370366. Available at: https://doi.org/10.1111/myc.12620 Accessed on 29/11/2020
NHS Wirral (2015). Medicines Formulary – Ear, nose and throat, v8. Available at: https://mm.wirral.nhs.uk/document_uploads/formulary/ENTmedicinesformularychaptSep12.pdf Accessed on 01/12/2020
NICE BNF (2020). Skin infections, antibacterial therapy. Available at: https://bnf.nice.org.uk/treatment-summary/skin-infections-antibacterial-therapy.html Accessed on 01/12/2020
NICE (2020). Impetigo: antimicrobial prescribing. Available at: https://www.nice.org.uk/guidance/ng153/chapter/Rationales Accessed on 02/12/20
Pankey GA, Sabath LD. Clinical relevance of bacteriostatic versus bactericidal mechanisms of action in the treatment of Gram-positive bacterial infections. Clin Infect Dis. 2004 Mar 15;38(6):864-70. doi: 10.1086/381972. Epub 2004 Mar 1. PMID: 14999632. Available at: https://doi.org/10.1086/381972 Accessed on 29/11/2020