Clobetasol + Gentamicin

Usage

Clobetasol + Gentamicin is prescribed for inflammatory skin conditions, especially those susceptible to or complicated by bacterial infections. These conditions include eczema, psoriasis, dermatitis, and other skin irritations. It is effective against a variety of bacterial skin infections and reduces associated symptoms like pain, itching, redness, and oozing.

• Pharmacological Classification:

  • Clobetasol: Corticosteroid (topical)
  • Gentamicin: Aminoglycoside antibiotic (topical)

• Mechanism of Action:

  • Clobetasol: Suppresses the immune response, reducing inflammation by decreasing the production of inflammatory chemicals, and constricting blood vessels.
  • Gentamicin: Inhibits bacterial protein synthesis, leading to bacterial cell death.

Alternate Names

No commonly used alternate generic names exist. Various brand names are used, including Clobesol-Gm, Etan-NC, Etan-G, CLOBETAMIL G, and others.

How It Works

• Pharmacodynamics:

  • Clobetasol exerts potent anti-inflammatory, antipruritic (anti-itch), and vasoconstrictive effects by binding to glucocorticoid receptors in the skin.
  • Gentamicin binds to bacterial ribosomes, inhibiting protein synthesis, ultimately killing the bacteria.

• Pharmacokinetics:

  • Absorption: Both drugs have limited systemic absorption when applied topically as directed. Systemic absorption can increase if applied to large areas, broken skin, or under occlusive dressings.
  • Metabolism: Clobetasol is primarily metabolized in the liver. Gentamicin is not metabolized.
  • Elimination: Clobetasol is excreted through urine and feces. Gentamicin is primarily excreted unchanged in the urine.

• Mode of Action:

  • Clobetasol: Modifies gene transcription and protein synthesis related to inflammation.
  • Gentamicin: Interferes with bacterial ribosomal function, disrupting protein synthesis.

• Receptor Binding/Enzyme Inhibition:

  • Clobetasol: Binds to glucocorticoid receptors.
  • Gentamicin: Inhibits bacterial ribosomal function.

Dosage

Standard Dosage

Adults: Apply a thin layer to affected areas 1-2 times daily. Do not exceed 50 g per week. Limit use to 2 weeks for inflammation/itching and up to 4 weeks for plaque psoriasis (depending on product and local guidelines).

Children: Use in children under 12 is generally not recommended for Clobetasol + Gentamicin combination products. In children older than one year, similar dosage as adults can be used, but treatment duration is ideally limited to 5 days for ointment/cream and a few days for scalp solution. Review weekly. Foam is not recommended for children younger than 12.

Special Cases:

• Elderly Patients: May be more susceptible to side effects; caution and dosage adjustment may be necessary.
• Patients with Renal Impairment: Gentamicin dosage should be adjusted based on renal function.
• Patients with Hepatic Dysfunction: Caution is advised with Clobetasol in patients with hepatic impairment.
• Patients with Comorbid Conditions: Monitor patients with diabetes for changes in blood glucose control.

Clinical Use Cases The dosages described below refer specifically to the use of gentamicin alone in these cases.

• Intubation/Surgical Procedures/Mechanical Ventilation/ICU Use/Emergency Situations: Gentamicin, not in combination with clobetasol, is sometimes used parenterally for serious infections in such settings. Dosages are determined individually and depend on factors such as the infection’s severity, patient’s weight, and renal function.

Dosage Adjustments

Adjustments may be required based on the specific condition, severity, patient response, and the presence of renal or hepatic impairment. Monitor patients for local and systemic side effects, especially with prolonged use.

Side Effects

Common Side Effects

Burning or stinging sensation, itching, skin dryness or cracking, redness, irritation, and thinning of the skin at the application site.

Rare but Serious Side Effects

Allergic reactions, skin atrophy, striae (stretch marks), telangiectasia (spider veins), hypopigmentation, hypertrichosis (increased hair growth), folliculitis, Cushing’s syndrome (with prolonged or extensive use), adrenal suppression.

Long-Term Effects

Skin atrophy, telangiectasia, striae, hypopigmentation, glaucoma, cataracts (with prolonged use near the eyes).

Contraindications

Hypersensitivity to clobetasol, gentamicin, or any other ingredients. Untreated skin infections (viral, fungal, mycobacterial), rosacea, acne, perioral dermatitis, perianal/genital pruritus. Children below 1 year and nappy rash. Avoid use on broken or damaged skin or within skin folds.

Drug Interactions

• CYP450 Interactions: Minimal CYP450 interactions are expected with topical application.
• Other Interactions:
  • Ritonavir, Itraconazole: May increase the risk of side effects.
  • Other topical medications: Concurrent use may increase the risk of irritation or other adverse effects.

Pregnancy and Breastfeeding

• Pregnancy: Clobetasol + Gentamicin is a pregnancy category C drug. Use only if the potential benefit outweighs the risk to the fetus.
• Breastfeeding: Limited safety information. Exercise caution; ensure the infant does not come into contact with treated areas.

Drug Profile Summary

• Mechanism of Action: Clobetasol: Reduces inflammation and itching. Gentamicin: Kills bacteria.
• Side Effects: Burning, itching, dryness, skin thinning. Rarely: allergic reactions, adrenal suppression, Cushing’s syndrome.
• Contraindications: Hypersensitivity, viral/fungal/mycobacterial infections, rosacea, acne.
• Drug Interactions: Ritonavir, itraconazole.
• Pregnancy & Breastfeeding: Use with caution; consult a physician.
• Dosage: Apply thinly 1–2 times daily. Maximum 50g/week. Limit use to 2 weeks for most conditions, 4 weeks maximum for psoriasis (depending on product and guidelines).
• Monitoring Parameters: Skin condition, local and systemic side effects.

Popular Combinations

Miconazole is sometimes added to this combination to address fungal infections.

Precautions

Pre-screen patients for contraindications and allergies. Monitor for local and systemic side effects. Caution is advised for prolonged use, use in children, pregnant or breastfeeding women, and elderly patients. Avoid occlusion of treated areas. Wash hands after application. Avoid contact with eyes, nose, and mouth.

FAQs (Frequently Asked Questions)

Q1: What is the recommended dosage for Clobetasol + Gentamicin?

A: Apply a thin layer to affected areas once or twice daily. Do not exceed 50 g per week. Duration of therapy typically ranges from a few days to a maximum of two weeks for eczema, dermatitis, and other inflammatory skin disorders, to up to 4 weeks in psoriasis.

Q2: Can Clobetasol + Gentamicin be used on the face?

A: Use on the face should be minimized and limited to a few days. Prolonged facial application can cause skin atrophy and telangiectasia.

Q3: Can I use Clobetasol + Gentamicin during pregnancy or while breastfeeding?

A: Consult a physician before use during pregnancy or breastfeeding. If used during breastfeeding, ensure the infant does not come into contact with treated areas.

Q4: What are the most common side effects of Clobetasol + Gentamicin?

A: Burning, itching, dryness, and thinning of skin at the application site.

Q5: What should I do if my symptoms do not improve after using Clobetasol + Gentamicin?

A: Consult a physician. Do not continue use beyond the recommended duration without medical advice.

Q6: Can Clobetasol + Gentamicin be used for fungal infections?

A: No, Gentamicin is an antibacterial agent. This combination is not effective against fungal infections. A combination with an antifungal medication, such as miconazole, is needed.

Q7: How long does it take for Clobetasol + Gentamicin to work?

A: Improvement may be seen within a few days, but full benefit may take longer depending on the condition.

Q8: What should I do if I accidentally get Clobetasol + Gentamicin in my eyes?

A: Rinse thoroughly with water and consult a physician if irritation persists.

Q9: Can I cover the treated area with a bandage?

A: Unless specifically directed by a physician, avoid covering the treated area with a bandage or dressing as this can increase absorption and side effects.

Q10: Can I use Clobetasol + Gentamicin with other topical medications?

A: Inform your physician about all other medications you are using, including topical products. Concurrent use of multiple topical medications may increase the risk of irritation.