Topical antibiotic overuse in minor follicular disorders: A narrative review

Topical antibiotics have long been part of everyday skin infection management, yet their contribution to antimicrobial resistance (AMR) gets little attention compared to systemic agents. This is a gap worth addressing. In 2021, AMR was associated with 4.71 million deaths and hospitalizations. Many patients recover on their own or with non-antibiotic topical therapy. Topical antibiotics are commonly used for benign follicular problems such as folliculitis and superficial furunculosis. The narrative review investigates data relating cutaneous AMR to topical antibiotic abuse in minor follicular diseases, discusses overuse-prone prescribing procedures, debunks common misconceptions, assesses alternative therapy, and offers stewardship initiatives. Topical antibiotics, particularly fusidic acid and mupirocin, promote resistant strains of Staphylococcus aureus by applying long-term selective pressure to cutaneous pathogens. Resistance determinants on mobile genetic elements enable co-selection of resistance to untreated antibiotic classes. For minor furuncles, the Infectious Diseases Society of America has long favored incision and drainage over topical medicines. Antibiotics should only be administered to patients with severe cellulitis or impaired immune systems. Clinicians and patients continue to believe that topical antibiotics are safe. Benzoyl peroxide and antiseptics such as povidone iodine and chlorhexidine are examples of non-antibiotic substitutes that provide efficient treatment without encouraging resistance. One important yet preventable cause of cutaneous AMR is the use of topical antibiotics in mild follicular diseases. In order to address this, stewardship programs must be expanded to include topical agents, topical antibiotic use must be integrated into AMR surveillance, educational interventions must be implemented, and antibiotic-sparing alternatives must be promoted. Clinicians can preserve current agents while providing safe, effective care by switching to evidence -based, antibiotic-sparing strategies.