Usage
Beclometasone + Econazole + Gentamicin is a combination medication prescribed for inflammatory skin infections with suspected or confirmed bacterial and/or fungal components. It is indicated for conditions such as infected eczema, dermatitis, impetigo, psoriasis, diaper rash, lichen simplex chronicus, insect bites, infected burns, boils, otitis externa, and various dermatoses.
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Pharmacological Classifications:
- Beclometasone: Corticosteroid (anti-inflammatory, antipruritic)
- Econazole: Antifungal (imidazole derivative)
- Gentamicin: Antibiotic (aminoglycoside)
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Mechanism of Action: This triple combination addresses the multiple facets of infected, inflamed skin conditions. Beclometasone reduces inflammation and itching, econazole combats fungal infections, and gentamicin targets bacterial infections.
Alternate Names
There are various brand names under which this combination is marketed including Beclomate EG, Bestopic, Cucon GB, Ecodax-G, Ecogen B, and Miseco. Note that availability may vary regionally.
How It Works
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Pharmacodynamics:
- Beclometasone: Binds to glucocorticoid receptors, inhibiting inflammatory pathways, reducing vascular permeability and edema, and suppressing the migration of inflammatory cells.
- Econazole: Inhibits ergosterol synthesis, a crucial component of fungal cell membranes, thus disrupting membrane integrity and causing fungal cell death.
- Gentamicin: Binds to the 30S ribosomal subunit of bacteria, inhibiting protein synthesis and leading to bacterial cell death.
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Pharmacokinetics: Primarily topical application. Systemic absorption is minimal with intact skin, but can be higher with prolonged use over large areas, with inflamed or broken skin, and with occlusive dressings. Metabolism and excretion data on topical administration are limited. Systemic gentamicin is excreted primarily by the kidneys. Systemic econazole and beclometasone are primarily metabolized in the liver and excreted in the urine and feces.
Dosage
Standard Dosage
Adults: Apply a thin layer to the affected skin two to three times daily. Treatment duration varies depending on the infection, typically from a few days up to several weeks.
Special Cases:
- Elderly Patients: Monitor closely due to potential increased sensitivity to side effects and underlying reduced renal function.
- Patients with Renal Impairment: Systemic absorption is a concern with gentamicin component. Monitor for signs of nephrotoxicity and ototoxicity. Dosage adjustment may be necessary.
- Patients with Hepatic Dysfunction: Use with caution, especially if large areas are treated for prolonged periods, due to potential for increased systemic absorption of beclometasone and econazole.
- Patients with Comorbid Conditions: Use cautiously in patients with diabetes (beclometasone can affect glycemic control) and those with existing skin atrophy or other skin conditions.
Clinical Use Cases
This combination is generally not used in settings like intubation, surgical procedures, mechanical ventilation, or the ICU. It is intended for topical treatment of skin infections. It’s not typically used for emergency situations like cardiac arrest or status epilepticus.
Dosage Adjustments
Individualize dosage based on the patient’s response, the severity of the infection, and any underlying renal or hepatic dysfunction.
Side Effects
Common Side Effects:
Itching, burning, irritation, dryness, redness, or other application site reactions.
Rare but Serious Side Effects:
Allergic reactions (rash, hives, swelling, breathing difficulties), skin atrophy, hypopigmentation, telangiectasia, striae (with prolonged topical corticosteroid use), Cushing’s syndrome (with extensive or prolonged topical corticosteroid use). Ototoxicity and nephrotoxicity (with significant systemic gentamicin absorption).
Long-Term Effects:
Skin atrophy, telangiectasia, striae, hypopigmentation (with prolonged topical corticosteroid use).
Contraindications
Hypersensitivity to any component, rosacea, acne, perioral dermatitis, viral skin infections (herpes simplex, varicella, vaccinia), tuberculosis of the skin, syphilitic skin lesions, fungal infections not susceptible to econazole, and varicose ulcers.
Drug Interactions
While no significant drug interactions are reported with topical application, caution is advised with concomitant use of oral corticosteroids, NSAIDs, oral hypoglycemics, anticoagulants, other antifungals, and other antibiotics, particularly if there’s potential for systemic absorption of the topical medication.
Pregnancy and Breastfeeding
Use with caution during pregnancy and breastfeeding. Weigh the potential benefits against the potential risks to the fetus or infant. Although limited data is available, topical application poses a lower risk than systemic administration. Avoid applying to the nipple area during breastfeeding.
Drug Profile Summary
- Mechanism of Action: Anti-inflammatory, antifungal, and antibacterial.
- Side Effects: Itching, burning, irritation at application site (common); skin atrophy, Cushing’s syndrome, ototoxicity, nephrotoxicity (rare but serious).
- Contraindications: Hypersensitivity, rosacea, acne, viral skin infections.
- Drug Interactions: Few interactions are reported with topical use.
- Pregnancy & Breastfeeding: Use with caution.
- Dosage: Apply thinly 2-3 times/day.
- Monitoring Parameters: Skin reactions, signs of systemic absorption, renal function (if concerned about systemic gentamicin absorption).
Popular Combinations
This product is a popular combination. Further combinations are not typically recommended.
Precautions
Avoid contact with eyes, nose, and mouth. Do not use on broken or damaged skin. Use cautiously in children, the elderly, and pregnant or breastfeeding women. Monitor for hypersensitivity reactions. Do not use for longer than prescribed. Consult a physician for appropriate diagnosis and treatment duration.
FAQs (Frequently Asked Questions)
A: Apply a thin layer to the affected area two to three times daily. Dosage adjustments may be required for children, the elderly, and those with renal or hepatic impairment.
Q2: What are the common side effects?
A: Common side effects are typically limited to the application site and include itching, burning, redness, dryness, and irritation.
Q3: When is this medication contraindicated?
A: Contraindications include hypersensitivity to any component, rosacea, acne, viral skin infections (like herpes simplex or chickenpox), and varicose ulcers.
Q4: Can I use this cream on my face?
A: Use cautiously on the face as it can cause skin thinning and other side effects with prolonged use. Consult a doctor before use, especially on sensitive areas.
Q5: Can I use this during pregnancy or breastfeeding?
A: Consult your doctor. It’s generally used with caution in pregnancy and breastfeeding, and should only be used if the potential benefit outweighs the risk.
Q6: How long will it take to see improvement?
A: Improvement may be seen within a few days, but it can take several weeks for complete resolution. Continue using the medication for the prescribed duration even if symptoms improve.
Q7: What should I do if my condition worsens or doesn’t improve?
A: Contact your doctor promptly. You may need a different medication or further evaluation.
Q8: How should I store the medication?
A: Store as directed on the packaging, typically at room temperature and away from direct sunlight and moisture.
Q9: Can I use this cream with other topical medications?
A: Consult your doctor before combining with other topical medications, as it may increase the risk of side effects or interactions.
Q10: Should I cover the treated area with a bandage?
A: Generally, avoid using occlusive dressings unless specifically directed by your physician. They can increase the risk of systemic absorption of the medication, particularly the corticosteroid component.
