13.4.1 Topical corticosteroids with antimicrobials

Mild corticosteroid with antimicrobial

ChoiceDrugDosage
1st choiceHydrocortisone 1%/ clotrimazole 1%; cream (Canesten HC®)Dose:
Apply 1-2 times daily
or
Hydrocortisone 1% / miconazole nitrate 2%; cream and ointment (Daktacort®) Dose:
Apply 1-2 times daily
or
Hydrocortisone 1%/ fusidic acid 2% cream (Fucidin H®)Dose:
Apply 1-2 times daily
or
Hydrocortisone 0.5%, nystatin3%, benzalkonium chloride solution 0.2%, dimeticone “350” 10%; cream (Timodine®)Dose:
Apply 1-2 times daily

Moderately potent corticosteroid with antimicrobial

  • No licensed products in this category currently available.

Potent corticosteroid with antimicrobial

ChoiceDrugDosage
1st choiceBetamethasone (as valerate) 0.1%, fusidic acid 2%; cream and lipid cream (Fucibet®)Dose:
Apply 1-2 times daily

Prescribing Notes

  • The benefit of including antibacterials or antifungals with a topical corticosteroid is uncertain. Such combinations may have a place in inflammatory skin conditions associated with bacterial or fungal infection, such as infected eczema.
  • Sensitisation is more likely to occur with corticosteroid/ antimicrobial combinations than with topical corticosteroids alone. They are indicated for short term use only (usual maximum 2 weeks). Longer term use increases the risk of resistance and sensitisation.
  • The difference in potency between Fucidin H® (hydrocortisone 1%- mild corticosteroid ) and Fucibet® (betamethasone-potent corticosteroid) should be noted.
  • Prescribers should be aware that there is increasing resistance to fusidic acid; prudent use is encouraged to preserve the systemic efficacy of this antibiotic for life-threatening infections. Treatment with Fucidin H® or Fucibet® should be for a maximum of 7 days to prevent bacterial resistance. These products are not suitable for “repeat prescriptions”.
  • Consider whether oral antibiotics are more appropriate. Topical treatment is useful for small areas of skin infection (e.g. in flexure areas and skin folds) but, if the infection is more widespread, then an oral agent may be more suitable.

Cautions

See section 13.10.2 for cautions.