13.10.1.2. Antibacterial preparations also used systemically

ChoiceDrugDosage
1st choice

Fusidic acid 2% cream
(Sodium fusidate 2% ointment)

Dose:
Apply 3-4 times daily

Or
Metronidazole 0.75% cream/gelDose:
Apply thinly twice daily as per product literature

Prescribing Notes

  • To avoid the development of resistance, topical mupirocin or fusidic acid should only be used for localised infections and not be used for longer than 7 days. Local microbiology advice should be sought before using in hospital.
  • For acute impetigo topical antibiotics should be reserved for very localised lesions. Small areas of the skin may be treated by short-term topical application of fusidic acid three to four times a day.
  • If impetigo is extensive or long-standing an oral antibacterial such as flucloxacillin (or erythromycin in penicillin allergic) should be used.
  • Hydrogen peroxide cream (Crystacide®) may be used as an alternative agent to topical antibiotics.
  • Silver sulfadiazine cream is used for infected burns and ulcers.
  • Topical antibacterials should be avoided in leg ulcers unless used for short courses for defined infections, treatment of bacterial colonization is generally inappropriate.
  • Metronidazole gel is helpful for secondary infections of fungating tumours.

Caution

  • Mupirocin (Bactroban®) ointment should not be used in conditions where absorption of large quantities of polyethylene glycol is possible, especially if there is evidence of moderate or severe renal impairment.