fusidic acid + hydrocortisone acetate: clinical use

Prescribing considerations

• Confirm clinical secondary bacterial infection rather than colonisation alone.
• Prolonged, continuous or recurrent exposure may cause corticosteroid toxicity and fusidic-acid resistance.
• Reassess worsening or inadequate response; corticosteroid activity can mask resistant or uncontrolled infection.
• Consider systemic absorption when treating large areas, damaged skin, skin folds, occluded areas or children.
• Avoid contact with eyes, wounds or mucous membranes.
• Warn about the increased flammability of contaminated clothing, bedding and dressings.

Contraindications and cautions

• Hypersensitivity to either active ingredient or an excipient
• Untreated or uncontrolled primary fungal, viral or bacterial skin infection
• Untreated or uncontrolled cutaneous tuberculosis
• Perioral dermatitis
• Rosacea

Monitoring

• Clinical response and evidence of spreading or resistant infection
• Local irritation, contact dermatitis or worsening eczema
• Skin atrophy and other corticosteroid effects during repeated or extensive exposure
• Visual symptoms when used near the eyes
• Features of adrenal suppression or Cushing's syndrome where systemic absorption is plausible
• Rebound inflammation or suspected topical steroid withdrawal after stopping

Clinical pharmacology

Fusidic acid inhibits bacterial protein synthesis. Hydrocortisone acetate is a mild corticosteroid with anti-inflammatory and antipruritic effects. Absorption varies with skin integrity, application site and occlusion.

Formulation and product differences

• The selected product is a white cream for cutaneous use.
• Butylhydroxyanisole, cetyl alcohol and potassium sorbate may cause local reactions; butylhydroxyanisole may also irritate eyes and mucous membranes.
• Polysorbate 60 can cause allergic reactions.
• Fabrics contaminated with the cream burn more easily, and washing may not remove the hazard completely.