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13.4.1 Topical corticosteroids with antimicrobials

Mild corticosteroid with antimicrobial

ChoiceDrug
1st choice

Hydrocortisone 1%/ clotrimazole 1%; cream (Canesten HC®)*

*Do not prescribe the 15g OTC pack due to high cost

or

Hydrocortisone 1% / miconazole nitrate 2%; cream (Daktacort®)*

*Do not prescribe the 15g OTC pack due to high cost

or
Hydrocortisone 1%/ fusidic acid 2% cream (Fucidin H®)

Moderately potent corticosteroid with antimicrobial

ChoiceDrug
Reserve

clobetasone butyrate 0.05%, oxytetracycline 3%, nystatin 100,000 units per gram (Trimovate®)

  • Trimovate is expensive and less costly options should be considered where appropriate.

Potent corticosteroid with antimicrobial

ChoiceDrug
1st choiceBetamethasone (as valerate) 0.1%, fusidic acid 2%; cream and lipid cream (Fucibet®)
or
Betamethasone 0.05%, clotrimazole 1% cream (Lotriderm®)

Prescribing Notes

  • See also section 13.4 cautions (topical corticosteroids)
  • For people who are not systemically unwell, do not routinely offer either a topical or oral antibiotic for secondary bacterial infection of eczema. Refer to NICE NG190 visual summary
  • Sensitisation is more likely to occur with corticosteroid/ antimicrobial combinations than with topical corticosteroids alone. They are indicated for short term use only (typically 5-7 days). 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”.

Cautions

  • Topical miconazole can enhance the anticoagulant effect of warfarin—if miconazole and warfarin are used concurrently the anticoagulant effect should be carefully monitored and, if necessary, the dose of warfarin reduced. See MHRA
  • Patients taking warfarin should not use over the counter miconazole oral gel (Daktarin). If you plan to prescribe miconazole oral gel in a patient on warfarin, you should closely monitor them and advise that if they experience any sign of bleeding they should stop miconazole oral gel and seek immediate medical attention. For further information see MHRA

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