Usage
This combination medication is prescribed for the topical treatment of inflammatory skin disorders complicated by bacterial and fungal infections. These include:
- Infected eczema or dermatitis
- Intertrigo
- Secondarily infected fungal infections (e.g., athlete’s foot)
- Minor infected wounds or burns
- Otitis externa
Pharmacological Classification:
- Corticosteroid (Beclometasone)
- Antibacterial (Gentamicin, Clioquinol)
- Antifungal (Tolnaftate, Clioquinol)
Mechanism of Action: This combination provides a multifaceted approach to treating skin infections:
- Beclometasone: Reduces inflammation, itching, and swelling.
- Clioquinol: Combats both bacterial and fungal infections.
- Gentamicin: Kills bacteria, especially Gram-negative strains.
- Tolnaftate: Inhibits fungal growth.
Alternate Names
- Quard Cream
- Naderm Cream
- Angloderm Cream
- Betamethasone + Clioquinol + Gentamicin + Tolnaftate Cream/Ointment/Lotion
- Beclometasone + Clioquinol (Iodochlorhydroxyquin) + Gentamicin + Tolnaftate
How It Works
Pharmacodynamics:
- Beclometasone: Binds to glucocorticoid receptors, suppressing inflammatory mediators.
- Clioquinol: Disrupts microbial cell membrane stability.
- Gentamicin: Inhibits bacterial protein synthesis by binding to ribosomes.
- Tolnaftate: Inhibits fungal ergosterol biosynthesis, compromising cell membrane integrity.
Pharmacokinetics:
- Topical application results in minimal systemic absorption, with most of the drug remaining localized.
Elimination:
- Primarily through renal and hepatic pathways.
Dosage
Standard Dosage
Adults:
Apply a thin layer to the affected area two to three times daily. Treatment duration depends on the infection’s severity and location, typically 2-4 weeks. Do not use continuously for extended periods.
Children:
Use in children under 2 years of age is not recommended. For children over 2, the dosage should be determined by a physician, keeping in mind the child’s age and the infection’s severity. Avoid application on large areas.
Special Cases:
- Elderly Patients: Generally, the standard adult dosage is applicable, but caution should be exercised in case of hepatic or renal impairment.
- Patients with Renal Impairment: Dosage adjustment may be necessary. Consult a nephrologist for recommendations.
- Patients with Hepatic Dysfunction: Dosage adjustment may be necessary. Consult a hepatologist for recommendations.
- Patients with Comorbid Conditions: Individualized assessment is required for patients with conditions like diabetes, cardiovascular disease, or immune suppression.
Clinical Use Cases
This medication is for topical use only and is not applicable for systemic clinical scenarios such as intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations.
Dosage Adjustments
Modifications may be needed based on age, severity, response, and renal or hepatic function. Prolonged use may necessitate reduced frequency or potency.
Side Effects
Common Side Effects:
- Burning sensation
- Itching
- Skin irritation
- Dryness
- Erythema
Rare but Serious Side Effects:
- Allergic contact dermatitis (rash, pruritus, edema)
- Skin atrophy
- Hypopigmentation
- Hypertrichosis
- Secondary infection
Long-Term Effects:
- Skin atrophy
- Telangiectasia
- Striae
- Cushing’s syndrome (with extensive application, particularly in children)
Adverse Drug Reactions (ADR):
- Angioedema
- Stevens-Johnson syndrome (rare)
Contraindications
- Hypersensitivity to any component
- Primary viral skin infections (herpes simplex, varicella, vaccinia)
- Tuberculous or syphilitic skin lesions
- Rosacea
- Acne vulgaris
- Perioral dermatitis
Drug Interactions
- Oral anticoagulants (increased bleeding risk)
- Other topical corticosteroids (additive effects)
- NSAIDs (increased risk of gastrointestinal side effects)
- CYP3A4 inhibitors (e.g., itraconazole, ritonavir) may increase systemic absorption of beclometasone.
Pregnancy and Breastfeeding
Pregnancy Safety Category: C. Use only if the potential benefits outweigh the potential risks to the fetus. Consult a doctor before use. Excretion in breast milk and potential neonatal effects are not fully understood. Consult a doctor before use during breastfeeding.
Drug Profile Summary
- Mechanism of Action: Combines anti-inflammatory, antibacterial, and antifungal actions to treat skin infections.
- Side Effects: Common: burning, itching, irritation. Serious: skin atrophy, allergic reactions.
- Contraindications: Hypersensitivity, viral skin infections, rosacea, acne.
- Drug Interactions: Anticoagulants, other topical corticosteroids, NSAIDs.
- Pregnancy & Breastfeeding: Category C; use with caution. Consult a doctor.
- Dosage: Apply thinly 2-3 times daily for 2-4 weeks.
- Monitoring Parameters: Observe for signs of skin atrophy, infection worsening, or allergic reactions.
Popular Combinations
This medication itself is a popular combination and not typically combined with other topical agents. Oral or systemic medications may be prescribed concurrently for more severe or widespread infections.
Precautions
- Pre-screening for allergies and relevant medical conditions.
- Pregnant Women: Use cautiously after assessing risks and benefits.
- Breastfeeding Mothers: Exercise caution.
- Children & Elderly: Age-specific dosage considerations are essential.
- Lifestyle Considerations: Avoid excessive sun exposure. Inform patients about potential staining of clothing.
FAQs (Frequently Asked Questions)
A: Adults: Apply a thin layer 2-3 times daily for 2-4 weeks. Children over 2: Dosage should be determined by a physician. Not recommended for children under 2.
Q2: Can this cream be used on the face?
A: Use with caution on the face and for limited durations due to the increased risk of skin atrophy and other side effects.
Q3: What should I do if I miss a dose?
A: Apply the missed dose as soon as remembered, unless it’s almost time for the next dose. Do not double the dose.
Q4: Can I use this cream for any skin rash?
A: No, this cream is specifically for inflammatory skin conditions with bacterial and fungal components. Consult a doctor for diagnosis and appropriate treatment.
Q5: What are the signs of an allergic reaction to this cream?
A: Rash, itching, swelling, difficulty breathing. Seek immediate medical attention if these occur.
Q6: Can this cream be used during pregnancy?
A: It’s a Pregnancy Category C drug. Consult a doctor before use to weigh the benefits against potential risks.
Q7: Can I cover the treated area with a bandage?
A: Avoid using airtight dressings unless specifically instructed by a doctor.
Q8: How long will it take to see improvement?
A: This varies depending on the infection and individual response, but improvement is generally seen within a few days to a week. Consult a doctor if no improvement is observed within 2-4 weeks.
Q9: Are there any long-term side effects of using this cream?
A: Yes, prolonged use can lead to skin atrophy, telangiectasia, striae, and potentially Cushing’s syndrome with extensive application, particularly in children.
