Usage
Beclometasone + Ketoconazole + Neomycin is a topical combination medication primarily prescribed for inflammatory skin disorders complicated by bacterial and fungal infections. These infections include:
- Bacterial skin infections like impetigo or folliculitis.
- Fungal skin infections like tinea pedis (athlete’s foot), tinea cruris (jock itch), or tinea corporis (ringworm).
- Inflammatory skin conditions like eczema or dermatitis, with secondary bacterial/fungal infections.
Pharmacological Classification:
This medication combines three drug classes:
- Beclometasone: Corticosteroid (anti-inflammatory, antipruritic)
- Ketoconazole: Antifungal (imidazole derivative)
- Neomycin: Antibiotic (aminoglycoside)
Mechanism of Action:
- Beclometasone: Reduces inflammation and itching by suppressing the immune response and inhibiting the production of inflammatory mediators like prostaglandins.
- Ketoconazole: Inhibits fungal growth by disrupting the synthesis of ergosterol, a crucial component of the fungal cell membrane.
- Neomycin: Inhibits bacterial protein synthesis, leading to bacterial cell death.
Alternate Names
This triple combination medication doesn’t have a universally recognized international nonproprietary name (INN). It is referred to by the combination of its active ingredients.
Brand Names:
Brand names vary depending on the manufacturer and region. Some examples include:
- Dermitor KT
- Ketonate
- Various other generic formulations
How It Works
Pharmacodynamics:
- Beclometasone: Exerts its anti-inflammatory and antipruritic effects by binding to glucocorticoid receptors in the skin, modulating gene expression and ultimately reducing inflammation.
- Ketoconazole: Acts by inhibiting the enzyme 14-alpha-demethylase, which is essential for ergosterol synthesis in fungi. This leads to altered fungal cell membrane permeability and fungal cell death.
- Neomycin: Binds to the 30S ribosomal subunit in bacteria, interfering with protein synthesis and leading to bacterial cell death.
Pharmacokinetics:
Topical application minimizes systemic absorption. However, some absorption may occur, particularly with prolonged use over large areas or with occlusive dressings.
- Beclometasone: Metabolized primarily in the liver.
- Ketoconazole: Metabolized in the liver.
- Neomycin: Primarily excreted unchanged by the kidneys.
Dosage
Standard Dosage
Adults:
A thin layer is applied to the affected skin two to three times daily. Duration of treatment usually ranges from 2 to 4 weeks depending on the condition and physician’s assessment.
Children:
Use in children under 2 years is generally not recommended. For children older than 2 years, the dosage and duration should be determined by a physician and is typically lower than the adult dose.
Special Cases:
- Elderly Patients: Start with the lowest effective dose and monitor closely for adverse effects.
- Patients with Renal Impairment: Neomycin should be used with caution due to the potential for systemic absorption and nephrotoxicity.
- Patients with Hepatic Dysfunction: Use with caution, as both beclometasone and ketoconazole are metabolized in the liver.
- Patients with Comorbid Conditions: Monitor blood glucose levels in diabetic patients, as beclometasone can affect glucose metabolism.
Clinical Use Cases
The medication is specifically designed for topical dermatological use and hence is not used in settings like intubation, surgical procedures, mechanical ventilation, ICU, or emergency situations.
Dosage Adjustments
Adjustments to dosage may be necessary depending on patient-specific factors like renal or hepatic impairment. It is essential to follow the physician’s recommendations for dosage adjustments.
Side Effects
Common Side Effects
- Burning
- Itching
- Stinging
- Dryness
- Redness
- Irritation at the application site
Rare but Serious Side Effects
- Allergic contact dermatitis
- Skin atrophy
- Hypopigmentation
- Telangiectasia
- Secondary infection
Long-Term Effects
Prolonged use of topical corticosteroids can lead to skin atrophy, telangiectasia, and striae.
Adverse Drug Reactions (ADR)
Severe allergic reactions are rare but require immediate medical attention. Symptoms may include rash, itching, swelling, dizziness, or difficulty breathing.
Contraindications
- Hypersensitivity to any of the components.
- Viral skin infections (e.g., herpes simplex, varicella).
- Tuberculosis or syphilitic skin lesions.
- Rosacea or acne.
- Generally contraindicated in children under 2 years of age.
Drug Interactions
- Concurrent use of other topical steroids can increase the risk of side effects.
- Oral corticosteroids may interact with topical beclometasone.
- Ketoconazole is a CYP3A4 inhibitor and can interact with drugs metabolized by this enzyme.
- Neuromuscular blocking agents may interact with neomycin.
Pregnancy and Breastfeeding
Consult a physician before use during pregnancy or breastfeeding. Topical application minimizes systemic absorption, but potential benefits should be weighed against risks.
Drug Profile Summary
- Mechanism of Action: Combination of a corticosteroid (anti-inflammatory), an antifungal, and an antibiotic.
- Side Effects: Burning, itching, stinging, dryness, redness, and irritation; rarely, skin atrophy, hypopigmentation.
- Contraindications: Hypersensitivity, viral skin infections, tuberculosis/syphilitic lesions, acne, rosacea.
- Drug Interactions: Other topical steroids, oral corticosteroids, CYP3A4 substrates, neuromuscular blockers.
- Pregnancy & Breastfeeding: Consult a physician before use.
- Dosage: Apply a thin layer 2-3 times daily, duration 2-4 weeks, as directed by a physician.
- Monitoring Parameters: Observe the treated area for improvement or adverse reactions. Monitor blood glucose in diabetic patients.
Popular Combinations
This medication itself is a popular combination.
Precautions
- General Precautions: Avoid contact with eyes, nose, and mouth. Wash hands after application.
- Specific Populations: See Dosage - Special Cases and Pregnancy and Breastfeeding.
- Lifestyle Considerations: Avoid excessive sun exposure, as it can exacerbate skin irritation.
FAQs (Frequently Asked Questions)
A: Apply a thin layer to the affected area 2-3 times daily. The duration is typically 2-4 weeks, but it should be determined by a physician.
Q2: Can this cream be used on the face?
A: Use with caution on the face, especially on thin skin areas. Avoid prolonged use.
Q3: What if I miss a dose?
A: Apply the missed dose as soon as you remember, unless it’s almost time for the next dose. Do not apply extra to make up for a missed dose.
Q4: Can I use this cream with other topical medications?
A: Consult your physician before combining this cream with other topical medications, as interactions may occur.
Q5: How long does 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 as prescribed, even if symptoms improve.
Q6: What are the signs of an allergic reaction?
A: Seek immediate medical attention if you experience rash, itching, swelling, dizziness, or difficulty breathing after applying the cream.
Q7: Can this medication be used during pregnancy?
A: Consult your physician before using this medication during pregnancy or breastfeeding.
Q8: Can children use this medication?
A: It’s generally not recommended for children under 2 years old. Consult a physician for appropriate dosing in older children.
Q9: What if my condition worsens or doesn’t improve?
A: Consult your physician if your condition doesn’t improve or worsens after a few weeks of use.
