Usage
Beclometasone + Fusidic acid is prescribed for inflammatory skin disorders, such as eczema and dermatitis, complicated by bacterial infection, especially those caused by Staphylococcus aureus. It combines the anti-inflammatory action of a corticosteroid (Beclometasone) with the antibiotic effect of Fusidic acid.
It’s pharmacological classifications are:
- Corticosteroid (Beclometasone)
- Antibiotic (Fusidic acid)
Beclometasone reduces inflammation by inhibiting the production of prostaglandins and other inflammatory mediators. Fusidic acid inhibits bacterial protein synthesis, thus stopping bacterial growth.
Alternate Names
While “Beclometasone + Fusidic Acid” is the common generic name, variations exist internationally and regionally. Beclomethasone may sometimes be used interchangeably with Beclometasone. Some popular brand names include Fucicort, Fucibet, and Fusidil B.
How It Works
Pharmacodynamics: Beclometasone, a glucocorticoid, exerts its anti-inflammatory effect by binding to glucocorticoid receptors in the cytoplasm. This complex then translocates to the nucleus, modulating gene transcription and ultimately suppressing the inflammatory cascade. Fusidic acid inhibits bacterial protein synthesis by binding to elongation factor G (EF-G), preventing translocation of the ribosome along mRNA.
Pharmacokinetics: Beclometasone, when applied topically, is absorbed percutaneously. The extent of absorption depends on factors like skin integrity and the use of occlusive dressings. It’s metabolized primarily in the liver and excreted via the kidneys and in bile. Fusidic acid, applied topically, has limited systemic absorption through intact skin. It primarily remains in the stratum corneum. However, some absorption can occur with compromised skin barrier or prolonged application, especially in children, leading to low systemic levels. It’s excreted primarily in bile, with minimal renal excretion.
Mode of Action: Beclometasone suppresses inflammation by binding to glucocorticoid receptors. Fusidic acid disrupts bacterial protein synthesis by binding to EF-G.
Elimination pathways: Both drugs are primarily excreted/eliminated through the hepato-biliary system, with Beclometasone having greater renal excretion than Fusidic Acid.
Dosage
Standard Dosage
Adults:
Apply a thin layer to the affected area twice daily. Treatment duration should not typically exceed two weeks.
Children:
Use in children should be under strict medical supervision due to increased risk of systemic absorption and side effects. Use on large areas of skin and for prolonged durations should be avoided. Apply a thin layer to the affected area, frequency, and duration based on age, weight, and disease severity, as determined by the physician.
Special Cases:
- Elderly Patients: Similar to adults, but monitor for skin atrophy with prolonged use.
- Patients with Renal Impairment: Caution advised; monitor for systemic side effects if using over large areas or for prolonged periods.
- Patients with Hepatic Dysfunction: Caution advised; monitor for systemic side effects if using over large areas or for prolonged periods.
- Patients with Comorbid Conditions: Use with caution in patients with diabetes, Cushing’s syndrome, glaucoma, or other conditions that may be exacerbated by corticosteroids.
Clinical Use Cases
Beclometasone + Fusidic Acid is intended for topical use on the skin. It is not relevant to clinical scenarios such as intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations.
Dosage Adjustments
Dosage adjustments should be made based on patient response, disease severity, and the presence of any adverse effects. In patients with renal or hepatic impairment, close monitoring for systemic side effects is recommended, especially with prolonged use or application over large skin areas.
Side Effects
Common Side Effects
Itching, burning, irritation, dryness, redness, and rash at the application site.
Rare but Serious Side Effects
Skin atrophy, telangiectasia (spider veins), hypopigmentation, hypertrichosis (increased hair growth), perioral dermatitis, allergic contact dermatitis. Systemic effects like adrenal suppression (with prolonged use over large areas, particularly in children).
Long-Term Effects
Skin thinning, striae (stretch marks), and changes in skin pigmentation.
Adverse Drug Reactions (ADR)
Severe allergic reactions (rare).
Contraindications
Hypersensitivity to either Beclometasone, Fusidic acid, or any component of the formulation. Rosacea, acne, perioral dermatitis, primary bacterial, viral (e.g., herpes simplex, chickenpox), or fungal skin infections, tuberculosis or syphilis of the skin, open wounds, or ulcers.
Drug Interactions
Clinically significant interactions with topical application are rare. However, concomitant use of potent CYP3A4 inhibitors, especially over large areas or with occlusive dressings, might theoretically increase systemic absorption and side effects of Beclometasone. Avoid concomitant use with other topical corticosteroids.
Pregnancy and Breastfeeding
Use only if clearly needed and the potential benefits outweigh the risks. Topical application minimizes fetal exposure. If used during breastfeeding, avoid application on the breasts to prevent infant ingestion.
Drug Profile Summary
- Mechanism of Action: Beclometasone: anti-inflammatory glucocorticoid, Fusidic acid: antibiotic inhibiting bacterial protein synthesis.
- Side Effects: Common: Itching, burning, irritation, dryness, redness, rash at application site. Serious: Skin atrophy, telangiectasia, hypopigmentation, hypertrichosis, allergic contact dermatitis, adrenal suppression.
- Contraindications: Hypersensitivity, rosacea, acne, perioral dermatitis, viral/fungal/TB/syphilis skin infections, open wounds/ulcers.
- Drug Interactions: Limited with topical use; potential interaction with potent CYP3A4 inhibitors when applied over large areas.
- Pregnancy & Breastfeeding: Use with caution if benefits outweigh risks; avoid breast application during lactation.
- Dosage: Adults and children: Thin layer twice daily for up to 2 weeks; adjust for children based on age, weight, and condition.
- Monitoring Parameters: Monitor for local skin reactions and signs of systemic absorption (e.g., Cushingoid features in children).
Popular Combinations
Typically not combined with other drugs topically due to its dual action.
Precautions
Do not apply near eyes, mouth, or open wounds. Do not occlude treated area unless directed by physician. Do not use on broken skin. Wash hands after application.
FAQs (Frequently Asked Questions)
A: Adults and children: A thin layer applied twice daily for up to two weeks. Duration of treatment in children should be minimized.
A: Use with caution and for limited durations on the face due to the risk of skin thinning, telangiectasia, and perioral dermatitis.
Q3: Can it be used for all types of skin infections?
A: No, it’s only for inflammatory skin conditions with bacterial superinfections. Not effective for viral or fungal infections.
Q4: What should I do if my condition doesn’t improve?
A: Consult a physician. The infection might require a different antibiotic or the diagnosis may need to be re-evaluated.
Q5: Are there any long-term side effects of using this cream?
A: Yes, prolonged use can lead to skin thinning, stretch marks, and changes in skin pigmentation.
A: Consult your doctor first. While generally considered low risk when applied topically, it should only be used if benefits outweigh risks. Avoid application to the breasts if breastfeeding.
Q7: Can I use this cream on my child?
A: Consult a pediatrician. Children are more susceptible to systemic side effects, so usage should be carefully monitored and limited in duration and area of application.
Q8: What should I do if I accidentally get the cream in my eyes?
A: Rinse immediately and thoroughly with water. If irritation persists, seek medical advice.
Q9: Can I use this over broken skin or open wounds?
A: No. Avoid application on open wounds or broken skin.
Q10: Can I cover the treated area with a bandage?
A: Avoid occluding the treated area unless specifically instructed by your doctor. Occlusion can increase systemic absorption and side effects.
