April 28, 2021

Best OTC Antibiotic Ointment (Neosporin vs Bacitracin vs Triple Antibiotic)

There are many different over-the-counter antibiotic ointments available for purchase from pretty much any pharmacy or store out there. But which one is the best? Is there a best? What is the difference among them?

In each gram of bacitracin ointment, there is 500 units only. Nothing else.

For Neosporin, each gram contains the following:

- neomycin 3.5mg

- polymyxin B 5000 units

- bacitracin 400 units

For Triple Antibiotic, each gram contains:

- neomycin 3.5mg

- polymyxin B 5000 units

- bacitracin 400 units

As you can see, both neosporin and triple antibiotic are identical. The only difference is the name.

So, going back to the original question of which ointment is the best... The answer actually is not straightforward.

Neosporin and triple antibiotic contain neomycin and polymyxin B which are much better than bacitracin in addressing gram negative type of germs (ie, pseudomonas). Furthermore, both also contain bacitracin whereas bacitracin ointment alone contains just bacitracin which has good activity against gram positive type of germs which account for the vast majority of skin infections (ie, staph and strep). 

As such, neosporin and triple antibiotic has greater broad spectrum ability to kill many more germs than bacitracin alone.

So at first blush, it appears that neosporin and triple antibiotic would be considered the best antibiotic ointment.

But wait... If the vast majority of skin infections are due to gram positive organisms and bacitracin is the best ointment for this class of germs, AND bacitracin ointment has 25% more of the bacitracin ingredient than the other two, then bacitracin ointment should be the best.

Furthermore, about 10% of people are or become allergic to neomycin. In such neomycin allergic individuals, applying neosporin or triple antibiotic will make the skin MORE irritated and red (allergic contact dermatitis). As such, whenever the skin infection appears to get worse immediately after ointment application, it may not be due to worsening infection, but rather due to development of an allergic reaction.

It is because of the neomycin allergy concern as well as bacitracin's predominant gram positive activity that most doctors recommend bacitracin ointment as the best ointment to use. However, do keep in mind that bacitracin can also cause an allergic skin reaction.

In the end, I typically tell patients to continue using whatever antibiotic ointment they already have at home.

Otherwise, I suggest bacitracin ointment for use on the skin of the face, head, and neck. If the issue is mainly around the nasal opening or immediately around the lips, I suggest neosporin or triple antibiotic ointment. And be on the lookout for possible allergic skin reaction if the infected area looks worse!

Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids.

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