Other routes of administration for antimicrobials
Nebulised antimicrobials are typically restricted to use in specific circumstances (eg Pneumocystis jirovecii pneumonia, cystic fibrosis).
Topical antimicrobial therapy should be restricted to certain indications (eg bacterial conjunctivitis) because of the risk of promoting resistance. Topical antimicrobial therapy (eg ointments, solutions, powders) applied to a wound or a surgical incision for surgical antibiotic prophylaxis is not recommended, because there is potential for harm (eg hypersensitivity reactions, bacterial resistance) and inadequate evidence to support a benefit (see Principles of surgical antibiotic prophylaxis). The use of topical antimicrobial therapy for these indications is not currently approved by the Therapeutic Goods Administration (TGA).
Antimicrobial-impregnated cement is routinely used for some orthopaedic procedures (eg fixation of prosthetic devices) – see Surgical prophylaxis for orthopaedic surgery for more information. Commercial antimicrobial-impregnated cement products are available; however, adding additional antimicrobial(s) to commercial cements is off-label1 for more information. Commercial antimicrobial-impregnated cement products are available; however, adding additional antimicrobial(s) to commercial cements is off-label and is not recommended.
Discuss off-label1 use of an antimicrobial with the patient and explain the rationale for use. In line with good clinical practice, obtain informed consent before prescribing off label. Prescribers should be able to justify off-label use of a medicine with evidence. If a drug is used off-label, the clinician takes responsibility for monitoring the outcomes, effectiveness and adverse effects of the drug.