Usage
Beclometasone + Gentamicin + Ketoconazole is a topical combination medication primarily prescribed for inflammatory skin infections caused by fungi and bacteria. It’s effective against conditions like athlete’s foot (tinea pedis), jock itch (tinea cruris), ringworm (tinea corporis), and other dermatophytoses and candidiasis. This combination is particularly useful when inflammation, itching, and secondary bacterial infection accompany the fungal infection.
Pharmacological Classifications:
- Beclometasone: Corticosteroid (anti-inflammatory, antipruritic)
- Gentamicin: Aminoglycoside antibiotic (bactericidal)
- Ketoconazole: Imidazole antifungal (fungistatic/fungicidal)
Mechanism of Action: Beclometasone reduces inflammation and itching by suppressing the immune response. Gentamicin inhibits bacterial protein synthesis, leading to bacterial cell death. Ketoconazole disrupts fungal cell membrane synthesis by inhibiting ergosterol production.
Alternate Names
This triple combination medication is not widely known by an international non-proprietary name (INN). It is usually referred to by the names of its constituents. Brand names vary depending on the region and manufacturer. Some examples of Brand names are Kenozole BG Cream.
How It Works
Pharmacodynamics:
- Beclometasone: Binds to glucocorticoid receptors, reducing inflammation by decreasing vascular permeability, inhibiting leukocyte migration, and suppressing inflammatory mediator release.
- Gentamicin: Irreversibly binds to bacterial 30S ribosomal subunits, inhibiting protein synthesis and causing cell death.
- Ketoconazole: Inhibits fungal cytochrome P450 enzymes, specifically 14-alpha-demethylase, which disrupts ergosterol synthesis, a critical component of the fungal cell membrane. This leads to increased cell membrane permeability and fungal cell death.
Pharmacokinetics:
Topical application limits systemic absorption. A small amount of Beclometasone may be absorbed, metabolized in the liver, and excreted in the urine and feces. Gentamicin is minimally absorbed topically. Ketoconazole absorption is also limited after topical application. Any absorbed Ketoconazole is metabolized by the liver (primarily via CYP3A4) and excreted in the feces and urine.
Dosage
Standard Dosage
Adults: A thin layer of cream is usually applied to the affected area twice daily, in the morning and evening for 1-2 weeks depending on the infection. Consult specific product labeling as concentrations may vary.
Special Cases:
- Elderly Patients: Use with caution. Monitor for skin thinning and other adverse effects.
- Patients with Renal Impairment: Topical application minimizes risk; however, caution is advised.
- Patients with Hepatic Dysfunction: Topical application minimizes risk; however, caution is advised.
- Patients with Comorbid Conditions: Caution in patients with diabetes, immunosuppression, or those with compromised skin barrier function.
Clinical Use Cases
The provided sources do not contain dosing recommendations for clinical use cases such as intubation, surgical procedures, mechanical ventilation, intensive care unit (ICU) use, or emergency situations.
Dosage Adjustments
Adjustments may be needed based on severity, location, and response to therapy. Avoid prolonged use or application to large areas.
Side Effects
Common Side Effects
Burning, stinging, itching, irritation, dryness, redness, hypopigmentation (skin lightening) at the application site.
Rare but Serious Side Effects
Allergic contact dermatitis, skin atrophy, telangiectasia, folliculitis. Cushing’s syndrome or adrenal suppression may rarely occur with extensive use. Hypersensitivity reactions.
Long-Term Effects
Prolonged or excessive use can lead to skin thinning, striae, telangiectasia, and increased risk of secondary infections.
Adverse Drug Reactions (ADR)
Severe allergic reactions (angioedema, anaphylaxis), skin atrophy, Cushing’s syndrome.
Contraindications
Hypersensitivity to any component. Viral skin infections (herpes simplex, varicella zoster), tuberculosis, syphilis of the skin, rosacea, perioral dermatitis, acne. Open wounds or ulcerated lesions.
Drug Interactions
Other topical corticosteroids, antifungals, or antibiotics. Systemic use of ketoconazole can interact with numerous medications metabolized by CYP3A4 (e.g., warfarin, cyclosporine, some statins). Avoid concomitant use of other topical or systemic medications unless advised by a physician.
Pregnancy and Breastfeeding
Topical application likely poses minimal risk. However, caution is advised during pregnancy and breastfeeding. Consult a physician before use. Avoid application on breasts while breastfeeding.
Drug Profile Summary
- Mechanism of Action: Combined anti-inflammatory, antifungal, and antibacterial action for treating skin infections.
- Side Effects: Burning, stinging, itching, dryness, skin thinning.
- Contraindications: Hypersensitivity, viral skin infections, open wounds.
- Drug Interactions: Other topical or systemic corticosteroids, antifungals, antibiotics.
- Pregnancy & Breastfeeding: Caution advised; consult a physician.
- Dosage: Apply thinly twice daily.
- Monitoring Parameters: Monitor for local skin reactions and signs of systemic absorption (rare).
Popular Combinations
Not applicable, as this is already a triple combination product. Avoid using with other topical medications without medical advice.
Precautions
- General Precautions: Avoid contact with eyes, mucous membranes, and open wounds. Do not use occlusive dressings.
- Specific Populations: As discussed above.
- Lifestyle Considerations: No specific restrictions related to lifestyle have been outlined for topical application.
FAQs (Frequently Asked Questions)
A: Apply a thin layer to the affected area twice daily. Duration of treatment is typically 1-2 weeks and depends on the type of infection. Always consult product-specific information.
Q2: Can this combination be used on the face?
A: Generally, avoid using this combination on the face due to the risk of skin atrophy, telangiectasia, and perioral dermatitis. Consult a physician for facial skin infections.
Q3: What should I do if I miss a dose?
A: Apply the missed dose as soon as you remember. If it’s almost time for the next dose, skip the missed dose and continue with the regular schedule.
Q4: Can this be used for diaper rash?
A: Certain diaper rash formulations containing this combination exist. However, it’s crucial to confirm the diagnosis and ensure that the diaper rash is not solely due to irritation.
Q5: What if my symptoms worsen after using this cream?
A: Discontinue use and consult a physician immediately. It may indicate an allergic reaction, a resistant infection, or a different skin condition requiring alternative treatment.
Q6: Can I use this cream on open wounds?
A: No. This cream is contraindicated for open wounds or ulcerated lesions.
Q7: Is it safe to use this medication during pregnancy?
A: While topical application poses minimal systemic risk, consult a physician before using this combination during pregnancy to assess the benefit-risk ratio.
Q8: Can I use this cream with other topical medications?
A: Avoid using other topical medications concurrently unless specifically advised by a physician. Concomitant use could lead to drug interactions or worsen skin irritation.
Q9: What are the signs of an allergic reaction to this cream?
A: Signs of an allergic reaction can include increased itching, burning, redness, swelling, or the appearance of a rash beyond the application site. If any of these occur, stop use and consult a physician immediately.
