Allergic Contact Dermatitis and Topical Antibiotics

J. Desiree Douglas, MPA, PA-C


Dermatology Nursing 

In This Article

Patient Education

Because of the high rate of cross-sensitivities and cross-reactions between neomycin and other antibiotics, patients should list neomycin as a medical allergy for the rest of their lives. Advise neomycin-sensitive patients to avoid the following antibiotics:

  • Bacitracin

  • Butirosin (ambutylosin)

  • Gentamicin (Garamycin)

  • Streptomycin

  • Tobramycin (Nebcin)

  • Kanamycin

  • Paromomycin

  • Spectinomycin

Safe prescription topical antibiotic alternatives to use on superficial skin infections include Silvadene® cream, Ilotycin® ointment and mupirocin (Bactroban®) 2% ointment and cream (Rietschel & Fowler, 2008; Scheman et al., 2008). There are no safe over-the-counter topical antibiotic products. If the patient needs a product to use postoperatively or needs a product to help wound healing that does not contain an antimicrobial agent, he/she can use petroleum jelly, Aquaphor® ointment, and Biafine® cream (Scheman et al., 2008).

Neomycin can treat infections such as otitis externa and conjunctivitis. There are multiple prescription-only alternatives safe to use for patients with neomycin sensitivity. Floxin Otic® (ofloxacin), Ciprodex® otic suspension (ciprofloxacin/dexamethasone), Cipro HC Otic® suspension (ciprofloxacin/hydrocortisone), Orlex HC Otic® solution, and chloramphenicol are safe in the treatment of otitis externa in neomycin-sensitive patients (Rietschel & Fowler, 2008; Scheman et al., 2008).

The following are safe ophthalmic preparations: Ciloxan® ophthalmic ointment and solution (cipro-floxacin), Vigamox® ophthalmic solution (moxifloxacin), Ocuflox® ophthalmic solution (ofloxacin), sulfacetamide sodium ophthalmic ointment and solution, chloramphenicol ophthalmic ointment and solution, erythromycin ophthalmic ointment, Quixin® ophthalmic solution (levofloxacin), Chibroxin® ophthalmic solution (norfloxacin) and Ilotycin ophthalmic ointment (Rietschel & Fowler, 2008; Scheman et al., 2008).