chlorhexidine acetate + hydrocortisone + nystatin: clinical use

Prescribing considerations

• Confirm an infected inflammatory dermatosis with a likely pathogen susceptible to nystatin or chlorhexidine.
• Avoid prolonged corticosteroid exposure, particularly on the face, flexures, extensive areas, under occlusion or in infants.
• Discontinue if sensitisation or a new infection develops.
• Counsel about fire risk from paraffin-contaminated clothing, bedding and dressings.

Contraindications and cautions

• Tuberculous skin lesions.
• Hypersensitivity to an active substance or excipient.
• Known or suspected previous allergy to a chlorhexidine-containing product.

Monitoring

• Clinical response and persistent, resistant or new infection.
• Local hypersensitivity, blistering or worsening dermatitis.
• Rebound redness, burning or stinging after stopping following prolonged exposure.
• Systemic corticosteroid effects when extensive areas, occlusion or infant skin are involved.

Clinical pharmacology

Nystatin is fungistatic and fungicidal against susceptible Candida. Chlorhexidine has broad antibacterial activity. Hydrocortisone has vasoconstrictive, anti-inflammatory and antipruritic effects. Nystatin is not absorbed through intact skin; hydrocortisone can be absorbed through skin and metabolised systemically.

Formulation and product differences

• The product is a yellow, water-repellent ointment based on white soft paraffin and contains chlorhexidine as the acetate salt.