clobetasol propionate + neomycin + nystatin: clinical use

Prescribing considerations

• Reserve for resistant steroid-responsive dermatoses where secondary bacterial or candidal infection is present, suspected or likely.
• Use particular caution on the face, flexures, broken skin, large areas or under occlusion.
• Children absorb proportionally more topical corticosteroid; avoid occlusion and account for nappies acting as occlusive dressings.
• Consider neomycin sensitisation and renal or auditory toxicity if clinically significant absorption is possible.
• Avoid dilution because antimicrobial activity and formulation performance may be altered.

Contraindications and cautions

• Hypersensitivity to an active ingredient or another formulation ingredient; the cream is also contraindicated with peanut or soya allergy.
• Children younger than two years.
• Rosacea, acne vulgaris, perioral dermatitis or itching without inflammation.
• Primary viral, bacterial, fungal or yeast skin infection.
• Secondary infection involving Pseudomonas or Proteus species.
• Perianal or genital itching.
• Otitis externa with a perforated eardrum.

Monitoring

• Review response and reassess if infection persists, worsens or spreads.
• Check for skin atrophy, visible small blood vessels, sensitisation and withdrawal-type rebound.
• When systemic absorption is plausible, assess for adrenal suppression and other corticosteroid effects.
• Monitor growth in children receiving repeated exposure.
• If substantial neomycin absorption is suspected, assess renal function, hearing and neuromuscular function.

Clinical pharmacology

Clobetasol is a very potent glucocorticoid with anti-inflammatory effects. Neomycin is a bactericidal aminoglycoside, and nystatin disrupts susceptible fungal cell membranes, principally targeting Candida.

Formulation and product differences

• Cream and ointment contain the same active ingredients but have different bases.
• The cream contains arachis oil and is contraindicated with peanut or soya allergy.
• The ointment has a paraffin-based vehicle and does not list arachis oil.
• Both formulations can increase the flammability of contaminated fabric.

Cream

Route: Cutaneous

Strengths: 0.5 mg + 5 mg + 100000 units/g

Ointment

Route: Cutaneous

Strengths: 0.5 mg + 5 mg + 100000 units/g