betamethasone valerate + fusidic acid: clinical use

Prescribing considerations

• Confirm an inflammatory eczematous dermatosis with suspected or confirmed secondary bacterial infection; this combination is not intended for uncomplicated primary bacterial infection.
• Prolonged, recurrent, large-area or occluded exposure increases the risks of resistance, infection masking, cutaneous atrophy and systemic corticosteroid absorption.
• Children are more susceptible to HPA-axis suppression and Cushingoid effects, particularly with extensive or occluded exposure.
• Reassess worsening or uncontrolled infection and consider allergy, resistant organisms or an alternative diagnosis.

Contraindications and cautions

• Hypersensitivity to fusidic acid, betamethasone valerate or an excipient.
• Untreated or uncontrolled primary fungal, viral or bacterial skin infection.
• Systemic fungal infection.
• Untreated or uncontrolled cutaneous tuberculosis or syphilis.
• Perioral dermatitis or rosacea.

Monitoring

• Clinical response and control of secondary infection.
• Local irritation, contact allergy, skin atrophy and evidence of superinfection.
• Visual symptoms when used near the eyes.
• Features of systemic corticosteroid exposure when absorption risk is increased.
• Atypical rebound redness, burning, peeling or oozing after withdrawal.

Clinical pharmacology

Betamethasone valerate is a potent glucocorticoid with anti-inflammatory and antipruritic activity. Fusidic acid provides topical antibacterial activity. Penetration and corticosteroid absorption vary with skin condition, application site and occlusion.

Formulation and product differences

• The licensed product is a white cutaneous cream.
• Cetostearyl alcohol may cause local skin reactions, and chlorocresol may cause allergic reactions.
• The paraffin-containing cream can accumulate in fabric and increase flammability.
• Discard the tube three months after first opening and store it below 30°C in its original packaging.