In HZO/VZV treatment, which topical antibiotic is used for skin lesions?

• A. Erythromycin ointment bid
• B. Neomycin ointment
• C. Bacitracin ointment
• D. Mupirocin ointment

Answer: (A)

When HZO or VZV skin lesions are present, a topical antibiotic is used to prevent secondary bacterial infection on the affected skin, including eyelid skin. Erythromycin ointment is a macrolide that effectively covers the common skin pathogens Staphylococcus aureus and Streptococcus species, and it has a favorable safety profile with a low risk of contact dermatitis, especially around the eye. This makes it a reliable and well-tolerated choice for lesions near the ocular surface.

Neomycin ointment, while broad, is more likely to cause contact dermatitis, which is a concern on eyelid skin. Bacitracin has a narrower spectrum and may be less effective for typical secondary invaders. Mupirocin is excellent for certain localized skin infections like impetigo but is not the standard choice for these lesions around the eye and can be less practical in this setting.