Usage
Fusidic acid + hydrocortisone is prescribed for the treatment of infected eczematous dermatoses, including atopic dermatitis and contact dermatitis, when a bacterial infection, particularly Staphylococcus aureus, is suspected or confirmed. This combination targets skin conditions exhibiting inflammation and secondary bacterial infection.
It’s classified pharmacologically as an antibacterial and a corticosteroid combination. More specifically, it contains an antibiotic (fusidic acid) and an anti-inflammatory corticosteroid (hydrocortisone).
Fusidic acid works by inhibiting bacterial protein synthesis, thereby preventing bacterial growth and multiplication. Hydrocortisone reduces inflammation and itching by suppressing the immune response and the release of inflammatory mediators.
Alternate Names
While the generic name is fusidic acid + hydrocortisone, it is marketed under various brand names, most commonly Fucidin H.
How It Works
Pharmacodynamics: Fusidic acid exerts its antibacterial action by binding to elongation factor G (EF-G), thereby inhibiting protein synthesis in susceptible bacteria. Hydrocortisone exerts anti-inflammatory, antipruritic, and vasoconstrictive effects by binding to glucocorticoid receptors. It inhibits inflammatory responses including edema, fibrin deposition, capillary dilation, and phagocytic migration.
Pharmacokinetics: Fusidic acid, when applied topically, exhibits limited systemic absorption. The minimal amount absorbed is metabolized in the liver and excreted primarily in bile. Hydrocortisone applied topically can be absorbed systemically depending upon the application site, amount applied, and skin integrity. Absorbed hydrocortisone undergoes metabolism primarily in the liver and is excreted through the kidneys.
Mode of action (cellular/molecular level): Fusidic acid blocks bacterial protein synthesis by interfering with the translocation step. It stabilizes the complex formed by the ribosome, elongation factor G (EF-G), and guanosine diphosphate (GDP), preventing the binding of aminoacyl-tRNA to the ribosome and halting the addition of amino acids to the polypeptide chain. Hydrocortisone acts by binding to glucocorticoid receptors in the cytoplasm, which then translocate to the nucleus. These complexes modify gene transcription, resulting in the reduced production of inflammatory cytokines and increased production of anti-inflammatory proteins like lipocortin-1. It also suppresses leukocyte migration and phagocytosis, reducing inflammatory processes in the skin.
Elimination: Topically applied fusidic acid and hydrocortisone are minimally absorbed systemically. The absorbed fraction is metabolized mainly in the liver. Fusidic acid is primarily excreted in bile. Hydrocortisone metabolites are excreted mainly through the kidneys.
Dosage
Standard Dosage
Adults: Apply a thin layer to the affected area two to three times daily. Treatment duration is typically up to two weeks.
Children: The dosage is generally the same as for adults. However, children may be more susceptible to systemic side effects, particularly HPA axis suppression. Use with caution in children under 3 years old; consult specialist pediatric guidance for this age group.
Special Cases:
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Elderly Patients: Use with caution, as elderly patients may have thinner skin and be more prone to systemic absorption and side effects.
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Patients with Renal Impairment: No specific dosage adjustments are typically required for topical application.
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Patients with Hepatic Dysfunction: No specific dosage adjustments are typically required for topical application, although caution is advised.
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Patients with Comorbid Conditions: Monitor patients with diabetes, those who are immunocompromised, or those using other topical medications, particularly corticosteroids, for potential drug interactions and side effects.
Clinical Use Cases
The listed clinical use cases (intubation, surgical procedures, mechanical ventilation, ICU use, emergency situations) are not relevant for topical fusidic acid + hydrocortisone. It is intended for topical skin infections only and not for systemic use.
Dosage Adjustments
Dosage adjustments may be required based on the severity of the condition and patient response. Treatment should not exceed two weeks without re-evaluation by a doctor.
Side Effects
Common Side Effects
Application site reactions such as pruritus, burning, irritation, dryness, and erythema.
Rare but Serious Side Effects
Allergic reactions (e.g., rash, urticaria, angioedema), skin atrophy, telangiectasia, striae, hypopigmentation, hypertrichosis, perioral dermatitis, acneiform eruptions, secondary infections (fungal or bacterial), glaucoma (if applied near the eyes), adrenal suppression (with prolonged use or use over large areas).
Long-Term Effects
Skin atrophy, striae, telangiectasia, hypopigmentation.
Adverse Drug Reactions (ADR)
Severe allergic reactions, adrenal suppression, glaucoma.
Contraindications
Hypersensitivity to fusidic acid, hydrocortisone, or any of the excipients; primary skin infections caused by fungi, viruses, or bacteria that are untreated or uncontrolled; untreated or uncontrolled cutaneous tuberculosis; rosacea; perioral dermatitis; eruptions following vaccination.
Drug Interactions
No significant drug interactions have been reported with topical application. However, concomitant use of other topical corticosteroids should be avoided due to cumulative effects.
Pregnancy and Breastfeeding
Limited systemic absorption suggests minimal risk to the fetus. However, caution is advised, especially during the first trimester. Topical hydrocortisone acetate has been categorized as pregnancy class C by the FDA. Fucidin H cream may be used while breastfeeding, but it is advised to avoid applying it to the breasts.
Drug Profile Summary
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Mechanism of Action: Fusidic acid inhibits bacterial protein synthesis. Hydrocortisone provides anti-inflammatory and antipruritic effects.
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Side Effects: Common: Pruritus, burning, irritation. Serious: Allergic reactions, adrenal suppression, glaucoma.
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Contraindications: Hypersensitivity, untreated viral, fungal, or bacterial skin infections, tuberculosis, rosacea, perioral dermatitis.
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Drug Interactions: Minimal interactions expected with topical use.
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Pregnancy & Breastfeeding: Use with caution during pregnancy. Avoid applying to breasts during breastfeeding.
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Dosage: Apply thinly 2-3 times daily for up to 2 weeks.
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Monitoring Parameters: Monitor for skin irritation, allergic reactions, and signs of infection. Evaluate for potential systemic effects with prolonged use or use over large areas.
Popular Combinations
Fusidic acid + hydrocortisone is typically used as a single combination product. No other commonly used combinations are available.
Precautions
Avoid contact with eyes. Do not use with occlusive dressings unless directed by a physician. Use cautiously in children, elderly, and those with thin or broken skin. Limit use to 2 weeks and monitor for adverse effects.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Fusidic Acid + Hydrocortisone?
A: Apply a thin layer 2-3 times daily for up to 2 weeks. Adjust dosage according to patient response and clinical indication.
Q2: Can it be used on the face?
A: Yes, but avoid application near the eyes. Prolonged use on the face is not recommended due to the increased risk of skin atrophy, telangiectasia, and perioral dermatitis.
Q3: How long does it take to see improvement?
A: Improvement may be seen within a few days. If no improvement is observed after 7 days, re-evaluate the diagnosis and treatment plan.
Q4: Can I use it for acne?
A: No, fusidic acid + hydrocortisone is contraindicated in acne vulgaris, as the corticosteroid component can exacerbate the condition.
Q5: What if I miss a dose?
A: Apply the missed dose as soon as remembered, unless it is close to the time for the next dose. Do not apply extra cream to compensate for a missed dose.
Q6: Can I use it on broken skin?
A: Apply with caution to broken skin, ensuring that the area isn’t extensively damaged. Avoid applying to open wounds.
Q7: Is it safe to use during pregnancy?
A: Use with caution and only if the potential benefit outweighs the potential risk to the fetus, especially during the first trimester. Discuss potential risks with a physician.
Q8: What should I do if I develop an allergic reaction?
A: Discontinue use immediately and consult a doctor. Allergic reactions can manifest as rash, itching, swelling, and difficulty breathing.
Q9: Can I use it for longer than two weeks?
A: No, prolonged use beyond two weeks is not recommended without re-evaluation by a physician due to the risk of skin atrophy, telangiectasia, and adrenal suppression.
Q10: Can it be used for fungal skin infections?
A: No, it is contraindicated in untreated or uncontrolled primary fungal skin infections. The corticosteroid component could worsen these infections.
