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13.4.1 Topical corticosteroids with antimicrobials

Mild corticosteroid with antimicrobial

1st choice

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

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

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

Moderately potent corticosteroid with antimicrobial


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

1st choiceBetamethasone (as valerate) 0.1%, fusidic acid 2%; cream and lipid cream (Fucibet®)
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”.

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