Anti-infective skin preparations

 

Antibacterial preparations

Although there are a great many antibacterial drugs presented in topical preparations some are potentially hazardous and frequently their use is not necessary if adequate hygienic measures can be taken. Moreover, not all skin conditions that are oozing, crusted, or characterised by pustules are actually infected. Topical antibacterials should be avoided on leg ulcers unless used in short courses for defined infections; treatment of bacterial colonisation is generally inappropriate. To minimise the development of resistant organisms it is advisable to limit the choice of antibacterials applied topically to those not used systemically.

 

MUPIROCIN:

Indications: indicated for the topical treatment of secondarily infected traumatic lesions such as small lacerations, sutured wounds or abrasions (up to 10cm in length or 100cm2 in area), due to susceptible strains of Staphylococcus aureus and Streptococcus pyogenes.

Contraindications: History of hypersensitivity to mupirocin or any of the excipients.

Dose and Administration: Three times a day for up to 10 days, depending on the response.

 

SILVER SULFADIAZINE:

Indications: prophylaxis and treatment of infection in burn wounds; as an adjunct to short-term treatment of infection in leg ulcers and pressure sores; as an adjunct to prophylaxis of infection in skin graft donor sites and extensive abrasions; for conservative management of finger-tip injuries

Contraindications: pregnancy and breast-feeding; sensitivity to sulphonamides; not recommended for neonates

Dose and Administration: Burns, apply daily or more frequently if very exudative; leg ulcers or pressure sores, apply daily or on alternate days (not recommended if ulcer very exudative); finger-tip injuries, apply every 2–3 days.

 

ARGENIN ACID COLLOIDAL POLYMER:

Indications: superficial burns and grazes, postoperative wounds, pressure sores and ulcers.

Contraindications: History of hypersensitivity to mupirocin or any of the excipients.

Dose and Administration: apply a thick layer (5mm) onto the wound for 1-3 days depending on the nature of the wound.

 

FUSIDIC ACID:

Indications: Indicated either alone or in combination with systemic therapy, in the treatment of primary and secondary skin infections caused by sensitive strains of Staphylococcus aureus, streptococcus spp and Corynebacterium minutissimum. Primary skin infections that may be expected to respond to treatment with fusidic acid applied topically include: impetigo contagiosa, superficial folliculitis, sycosis barbae, paronychia and erythrasma; also such secondary skin infections as infected eczematoid dermatitis, infected contact dermatitis and infected cuts /abrasions.

Contraindications: Infection caused by non-susceptible organisms, in particular, Pseudomonas aeruginosa. contra-indicated in patients with hypersensitivity to fusidic acid and its salts.

Dose and Administration: Adults and Children: Uncovered lesions – apply gently, three or four times daily. Covered lesions – less frequent applications may be adequate.

 

GENTAMYCIN:

Indications: Bacterial Skin and Skin Structure Infection, Folliculitis, Furunculosis, Paronychia.

Contraindications: contra-indicated in patients with hypersensitivity to Gentamycin and its salts.

Dose and Administration: apply a small amount to the affected area by topical route 3 times per day.

 

Antifungal preparations

Most localised fungal infections are treated with topical preparations. To prevent relapse, local antifungal treatment should be continued for 1–2 weeks after the disappearance of all signs of infection. Systemic therapy is necessary for nail or scalp infection or if the skin infection is widespread, disseminated, or intractable. Skin scrapings should be examined if systemic therapy is being considered or where there is doubt about the diagnosis.

 

AMOROLFINE:

Indications: Dermatomycoses caused by dermatophytes: tinea pedis (athlete’s foot), tinea cruris, tinea inguinalis, tinea corporis, and tinea manuum. Pityriasis versicolor.

Contraindications: must not be reused by patients who have shown hypersensitivity to the treatment. No experience exists of use during pregnancy and nursing, therefore, the use of Loceryl should be avoided during pregnancy and lactation.

Dose and Administration: To be applied to affected skin areas once daily following cleansing (in the evening). The treatment should be continued without interruption until clinical cure, and for 3 – 5 days thereafter. The required duration of treatment depends on the species of fungi and on the localisation of the infection. In general, treatment should be continued for at least two to three weeks. With foot mycoses, up to six weeks of therapy may be necessary.

 

CLOTRIMAZOLE:

Indications: Fungal and Gram-positive bacterial skin and nail infections.

Contraindications: Possible hypersensitivity to clotrimazole.

Dose and Administration: Apply sparingly two or three times daily until two

weeks after clinical cure.

 

KETOCONAZOLE:

Indications: topical application in the treatment of dermatophyte infections of the skin such as tinea corporis, tinea cruris, tinea manus and tinea pedis infections due to Trichophyton spp, Microsporon spp and Epidermophyton spp. also indicated for the treatment of cutaneous candidosis (including vulvitis), tinea (pityriasis) versicolor and seborrhoeic dermatitis caused by Malassezia (previously called Pityrosporum) spp. P For the treatment of the following mycotic infections of the skin: tinea pedis, tinea cruris and candidal intertrigo.

Contraindications: Ketoconazole cream is contra-indicated in patients with a known hypersensitivity to any of the ingredients or to ketoconazole itself.

Dose and Administration: Tinea pedis apply twice daily; other fungal infections, apply 1–2 times daily.

 

MICONAZOLE NITRATE:

Indications: For the treatment of the following mycotic infections of the skin: tinea pedis, tinea cruris and candidal intertrigo.

Contraindications: contra-indicated in patients with a known hypersensitivity to any of the ingredients or to ketoconazole itself.

Dose and Administration: Apply twice daily continuing for 10 days after lesions have healed; nail infections, apply 1–2 times daily.

 

TERBINAFINE:

Indications: Fungal infections of the skin and nails caused by Trichophyton (eg. T. rubrum, T.mentagrophytes, T. verrucosum, T. violaceum), Microsporum canis and Epidermophyton floccosum. 1. Oral Lamisil is indicated in the treatment of ringworm (tinea corporis, tinea cruris and tinea pedis) where oral therapy is considered appropriate due to the site, severity or extent of the infection. 2. Oral Lamisil is indicated in the treatment of onychomycosis.

Contraindications: Hypersensitivity to Terbinafine. pregnancy, breast-feeding; avoid contact with eyes.

Dose and Administration: Apply thinly 1–2 times daily for up to 1 week in tinea pedis, 1–2 weeks in tinea corporis and tinea cruris, 2 weeks in cutaneous candidiasis and pityriasis versicolor; review after 2 weeks.

 

Combined Anti-infective and anti-inflammatory topical preparations

 

CLOTRIMAZOLE-BETAMETHASONE DIPROPIONATE:

Indications: Short-term topical treatment of tinea infections due to Trichophyton rubrum; T.mentagrophytes; Epidermophyton floccusum and Microsporum canis; candidiasis due to Candida albicans.

Contraindications: contraindicated in those patients with a history of sensitivity to any of its components or to other corticosteroids or imidazoles. Also contraindicated in facial rosacea, acne vulgaris, perioral dermatitis, napkin eruptions and bacterial or viral infections.

Dose and Administration: Adults and children over the age of 12 years: Topical administration twice daily for two weeks (tinea cruris, tinea corporis and candidiasis) or for four weeks (tinea pedis).

 

FUSIDIC ACID-BETAMETHASONE VALERATE:

Indications: indicated for the treatment of eczematous dermatoses including atopic eczema, infantile eczema, discoid eczema, stasis eczema, contact eczema and seborrhoeic eczema when secondary bacterial infection is confirmed or suspected.

Contraindications: Acne rosacea and perioral dermatitis. Skin lesions of viral, fungal or bacterial origin. Hypersensitivity to the preparation.

Dose and Administration: A small quantity should be applied to the affected area twice daily until a satisfactory response is obtained. A single treatment course should not normally exceed 2 weeks.

 

FUSIDIC ACID-HYDROCORTESONE:

Indications: indicated in eczema and dermatitis with secondary bacterial infections, including atopic eczema, primary irritant dermatitis and allergic and seborrhoeic dermatitis where the organisms responsible are known to be or believed to be sensitive to fusidic acid.

Contraindications: Hypersensitivity to fusidic acid and its salts. As with other topical corticosteroid preparations, It is contraindicated in primary bacterial, viral and fungal skin infections, skin manifestations in relation to tuberculosis or syphilis, perioral dermatitis and rosacea.

Dose and Administration: Adults and Children: Uncovered lesions – a small quantity should be applied to the affected area twice daily until a satisfactory response is obtained. A single treatment course should not normally exceed 2 weeks. Covered lesions – less frequent applications may be adequate.

 

MICONAZOLE NITRATE-HYDROCORTESONE:

Indications: For the topical treatment of inflamed dermatoses where infection by susceptible organisms and inflammation co-exist, eg intertrigo and infected eczema. Moist or dry eczema or dermatitis including atopic eczema, primary irritant or contact allergic eczema or seborrhoeic eczema including that associated with acne.

Contraindications: True hypersensitivity to any of the ingredients. Tubercular or viral infections of the skin or those caused by Gram-negative bacteria.

Dose and Administration: Apply the cream two or three times a day to the affected area, rubbing in gently until the cream has been absorbed by the skin.

 

NEOMYCIN-NATAMYCIN-HYDROCORTESONE:

Indications: to relieve the itching and discomfort of many skin problems where these also have an added bacterial and/or candidal (fungal) infection.

Contraindications: hypersensitivity to any of the ingredients.

Dose and Administration: applied sparingly to the affected area 2-4 times daily. Treatment should not be continued for longer than 14 days.

 

GENTAMYCIN-BETAMETHASONE:

Indications: Secondarily infected steroid-responsive dermatoses.

Contraindications: contra-indicated in patients with hypersensitivity to Gentamycin and betamethasone or its salts.

Dose and Administration: applied sparingly to the affected area 2-4 times daily. Treatment should not be continued for longer than 14 days.

 

MICONAZOLE NITRATE-BETAMETHASONE: 

Indications: infection of skin with fungi along with inflammation.

Contraindications: hypersensitivity to any of ingredients.

Dose and Administration: topical use once or twice daily.

 

MICONAZOLE NITRATE-GENTAMYCIN-BETAMETHASONE:

Indications: mixed infection of skin with fungi and bacteria along with

inflammation.

Contraindications: hypersensitivity to any of ingredients.

Dose and Administration: topical use once or twice daily.

 

MICONAZOLE NITRATE-MOMETASONE FUROATE:

Indications: for infections of skin by candida spp. Or dermatophytes in which

inflammatory and pruritic manifestations are prominent.

Contraindications: contraindicated in patients who are hypersensitive to

mometasone, miconazole or to any ingredient of the preparation.

Dose and Administration: apply a thin film to the affected skin areas once or

twice daily.

 

MICONAZOLE-GENTAMYCIN-MOMETASONE FUROATE:

Indications: mixed infection of skin with fungi and bacteria. These include atopic eczema, contact eczema, follicular eczema, infantile eczema, otitis externa, post traumatic infective eczema, neurodermatitis and psoriasis.

Contraindications: contraindicated in patients who are hypersensitive to any ingredient of the preparation.

Dose and Administration: apply a thin film to the affected skin areas once or twice daily.

 

Antiviral preparations

 

ACICLOVIR (Acyclovir):

Indications: indicated for the treatment of Herpes Simplex virus infections of the skin including initial and recurrent genital herpes and herpes labialis. Route of administration: topical. Do not use in eyes.

Contraindications: contraindicated in patients known to be hypersensitive to aciclovir, valaciclovir, propylene glycol or any of the excipients.

Dose and Administration: Adults and Children: Aciclovir Cream should be applied five times daily at approximately four hourly intervals, omitting the night time application. The cream should be applied to the lesions or impending lesions as soon as possible, preferably during the early stages (prodrome or erythema). Treatment can also be started during the later (papule or blister) stages. Treatment should be continued for at least 4 days for herpes labialis and for 5 days for genital herpes. If healing has not occurred then treatment may be continued for up to an additional 5 days.

 

Preparations for minor skin infections

 

ZINC OXIDE:

Indications: Napkin and urinary rash. Eczematous conditions.

Contraindications: hypersensitive to any of the ingredients.

Dose and Administration: Apply frequently even after improvement observed.

 

DEXAPANTHENOL:

Indications: gentle and soothing antiseptic cream, which can treat a variety of skin irritations.

Contraindications: hypersensitive to any of the ingredients.

Dose and Administration: Baby care- Apply Dexapanthen at each nappy change.

 

BETA-SITOSTEROL:

Indications: treatment of burns, wounds and skin ulcers.

Contraindications: hypersensitive to any of the ingredients.

Dose and Administration: a thin layer of the ointment should cover the whole

burn or wound bed and renewed 3-4 times daily if the area is left exposed or

twice daily if covered.

 

PURPLE CONEFLOWER JUICE:

Indications: treatment of surface wounds with a tendency to poor healing.

Contraindications: hypersensitive to any of the ingredients.

Dose and Administration: a thin layer of the ointment should cover the whole burn or wound bed and renewed 3-4 times daily if the area is left exposed or twice daily if covered.