chlorhexidine hydrochloride + hydrocortisone + nystatin: clinical use

Prescribing considerations

• Confirm that an infected inflammatory dermatosis requiring antifungal and/or antibacterial cover is present; hydrocortisone can suppress visible inflammation.
• Avoid contact with eyes and reassess if sensitivity, deterioration or new infection occurs.
• Systemic corticosteroid absorption is more likely over extensive areas or under occlusion.
• Avoid prolonged continuous topical corticosteroid exposure in infants because adrenal suppression can occur even without occlusion.
• Consider topical steroid withdrawal if intense redness, burning or stinging recurs and extends beyond the original area after treatment stops.

Contraindications and cautions

• Tuberculous skin lesions.
• Hypersensitivity to nystatin, chlorhexidine hydrochloride, hydrocortisone or an excipient.
• A possible previous allergic reaction to any chlorhexidine-containing product.

Monitoring

• Clinical response and signs that the diagnosis or antimicrobial coverage needs review.
• Local hypersensitivity, contact dermatitis or development of a new infection.
• Features of excess systemic corticosteroid exposure where absorption risk is increased.
• Rebound inflammation or suspected topical steroid withdrawal after stopping.

Clinical pharmacology

Nystatin has fungistatic and fungicidal activity, particularly against Candida albicans, and is not absorbed through intact skin or mucosa. Chlorhexidine is a broad-spectrum antiseptic. Hydrocortisone is a mild corticosteroid producing vasoconstrictive, anti-inflammatory, anti-oedema and antipruritic effects and can be absorbed through the skin.

Formulation and product differences

• The selected product is a light-yellow, water-miscible cream for topical use.
• The cream contains cetostearyl alcohol and benzyl alcohol, which may cause local reactions; these excipients should be considered when assessing intolerance.