Usage
Beclometasone + Econazole + Neomycin is a topical combination medication prescribed for inflammatory skin disorders complicated by secondary bacterial and fungal infections. These include:
- Eczema with secondary infection
- Dermatitis with secondary infection
- Psoriasis with secondary infection
- Superficial fungal infections with secondary bacterial infection (e.g., athlete’s foot, ringworm, jock itch)
Pharmacological Classification:
- Corticosteroid (Beclometasone)
- Antifungal (Econazole)
- Antibiotic (Neomycin)
Mechanism of Action: This triple combination provides a synergistic approach to treating skin infections. Beclometasone, a potent corticosteroid, reduces inflammation and itching. Econazole, an imidazole antifungal, inhibits fungal growth by disrupting cell membrane synthesis. Neomycin, an aminoglycoside antibiotic, combats bacterial infections by inhibiting protein synthesis.
Alternate Names
No widely recognized alternate names exist for the combination itself, though individual components have other names (e.g., Beclomethasone Dipropionate for Beclometasone). Numerous brand names exist depending on the region and manufacturer. Examples include Pruderm, and Bestozol NC.
How It Works
Pharmacodynamics: Beclometasone exerts anti-inflammatory, antipruritic, and vasoconstrictive effects. Econazole inhibits ergosterol synthesis, a crucial component of fungal cell membranes. Neomycin disrupts bacterial protein synthesis, leading to bacterial cell death.
Pharmacokinetics: Primarily topical application, minimizing systemic absorption. Some absorption may occur with prolonged use, application to large areas, or in children. Metabolism and elimination pathways for topical application are not fully characterized. Limited systemic absorption suggests hepatic metabolism and renal excretion.
Mode of Action: Beclometasone binds to glucocorticoid receptors, inhibiting inflammatory mediators. Econazole interferes with fungal cytochrome P450 enzymes, ultimately disrupting cell membrane formation. Neomycin binds to bacterial ribosomes, inhibiting protein synthesis.
Dosage
Standard Dosage
Adults: Apply a thin layer to the affected skin area twice daily.
Children: Use in children aged 2 years and above with caution and under medical supervision. Apply a thin layer twice daily, using the minimum amount necessary. Children are more susceptible to systemic absorption.
Special Cases:
- Elderly Patients: Use the minimum amount for the shortest duration. Monitor for systemic absorption.
- Patients with Renal Impairment: Dosage adjustments may be necessary. Consult a nephrologist.
- Patients with Hepatic Dysfunction: Exercise caution. Monitor for systemic effects.
- Patients with Comorbid Conditions: Use cautiously in patients with diabetes, glaucoma, cataracts, or a compromised immune system.
Clinical Use Cases
This medication is not systemically administered and is therefore not suitable for clinical settings like intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations. It is strictly intended for topical application on the skin.
Dosage Adjustments
Adjustments might be needed based on individual response, severity of infection, renal or hepatic impairment. Consult a specialist for guidance.
Side Effects
Common Side Effects:
- Burning sensation
- Itching
- Irritation
- Redness
- Dryness
- Skin thinning (with prolonged use)
Rare but Serious Side Effects:
- Allergic contact dermatitis
- Secondary infections
- Skin atrophy
- Telangiectasia (spider veins)
- Hypopigmentation
- Systemic absorption (with prolonged use or large area application)
Long-Term Effects:
- Skin atrophy
- Striae (stretch marks)
- Telangiectasia
- Hypertrichosis (excessive hair growth)
Adverse Drug Reactions (ADR):
- Angioedema
- Urticaria
- Hypersensitivity reactions
Contraindications
- Hypersensitivity to any of the components
- Viral skin infections (e.g., herpes simplex, chickenpox)
- Tuberculous skin infections
- Acne rosacea
- Perioral dermatitis
- Open wounds
- Children under 2 years old (for some formulations)
Drug Interactions
- Topical antibiotics (e.g., bacitracin): Increased risk of contact dermatitis.
- Other topical antifungals (e.g., ketoconazole): Limited additional benefit, increased adverse effects.
- Topical corticosteroids (e.g., hydrocortisone): Potentiates side effects.
- Oral anticoagulants (e.g., warfarin): Monitor for bleeding risk (rare).
- Polyene antibiotics (e.g., amphotericin B, nystatin): Antagonistic effects.
Pregnancy and Breastfeeding
Consult a physician before use. Use only if the potential benefit outweighs the risks. Limited data suggests minimal systemic absorption, but caution is advised. Topical application to the breast/nipple area should be avoided during breastfeeding.
Drug Profile Summary
Refer to information above.
Popular Combinations
This medication itself is a combination product. Additional combinations are generally not recommended.
Precautions
Refer to information above.
FAQs (Frequently Asked Questions)
A: Apply a thin layer to the affected area twice daily. Adjustments may be necessary for children, the elderly, and those with renal or hepatic impairment.
Q2: What skin conditions is this combination used for?
A: Inflammatory skin disorders with secondary bacterial and fungal infections, including eczema, dermatitis, psoriasis, and athlete’s foot.
Q3: Can this cream be used on the face?
A: Use on the face with caution and only under medical supervision due to increased sensitivity and potential for adverse effects.
Q4: What are the common side effects?
A: Burning, itching, irritation, redness, dryness, and skin thinning with prolonged use.
Q5: Are there any drug interactions I should be aware of?
A: Yes. Concurrent use with certain topical antibiotics, antifungals, or corticosteroids can potentiate side effects or create antagonistic effects. Inform your patients to disclose all medications they are using, including over-the-counter drugs.
Q6: Is this cream safe to use during pregnancy or breastfeeding?
A: Consult a physician before using during pregnancy or breastfeeding. Use only if the benefits outweigh the risks. Advise breastfeeding patients to avoid application to the nipple/breast area.
Q7: How long should treatment with this cream continue?
A: Treatment should not exceed seven days without medical supervision. Re-evaluate if the condition worsens or does not improve within seven days.
Q8: Can this cream be used on open wounds?
A: No. Avoid application to open wounds, cuts, or severely irritated skin.
Q9: What should I do if the cream gets into my eyes?
A: Rinse the affected eye immediately with cool water. If irritation persists, seek medical attention.
