Usage
Fusidic acid + mometasone is a topical combination medication primarily prescribed for inflammatory skin conditions complicated by bacterial infections. These include:
- Infected eczema
- Atopic dermatitis
- Impetigo
- Folliculitis
- Furunculosis
Pharmacological Classification:
- Fusidic acid: Antibiotic
- Mometasone: Corticosteroid
Mechanism of Action: Fusidic acid works by inhibiting bacterial protein synthesis, primarily affecting gram-positive bacteria like Staphylococcus aureus. Mometasone, a potent corticosteroid, reduces inflammation by suppressing the production of inflammatory mediators.
Alternate Names
This combination is known simply as mometasone + fusidic acid. Several brand names exist, including Bactirest-M, Mometone-F, Fusiwal M, and Fezigrip-M, among others. Availability and specific brand names may vary regionally.
How It Works
Pharmacodynamics: Fusidic acid acts as a bacteriostatic agent, preventing bacterial growth and replication. Mometasone exerts anti-inflammatory, antipruritic, and vasoconstrictive effects by binding to glucocorticoid receptors.
Pharmacokinetics:
- Absorption: Following topical application, systemic absorption of both components is minimal, especially with intact skin.
- Metabolism: Absorbed mometasone undergoes extensive hepatic metabolism. Fusidic acid’s metabolism is less well-defined in topical formulations.
- Elimination: Primarily renal excretion for mometasone, and primarily biliary excretion for fusidic acid.
Mode of Action: Fusidic acid inhibits bacterial protein synthesis by preventing the translocation of elongation factor G (EF-G) from the ribosome. Mometasone binds to glucocorticoid receptors in the cytoplasm, translocates to the nucleus, and modulates gene transcription, ultimately reducing inflammation.
Dosage
Standard Dosage
Adults: Apply a thin layer to the affected skin area twice daily. The treatment duration should generally not exceed two weeks.
Children: Use in children under 12 requires careful physician supervision. For children over 1 year, the adult dose may be used, but younger children may require dosage adjustments. One suggested pediatric dosing regimen is:
- <1 year: 50 mg (1 mL)/kg daily divided into 3 equal doses.
- 1-5 years: 250 mg (5 mL) three times a day.
-
5-12 years: 500 mg (10 mL) three times a day.
Always consult a doctor for appropriate pediatric dosing.
Special Cases:
- Elderly Patients: No specific dosage adjustments are usually required, but caution is advised due to age-related skin thinning.
- Patients with Renal/Hepatic Impairment: No specific dosage adjustments are generally recommended, but use with caution.
- Patients with Comorbid Conditions: Use cautiously in patients with diabetes, Cushing’s disease, cataracts, glaucoma, thyroid or pituitary diseases, and heart, liver, or kidney problems.
Clinical Use Cases
The use of fusidic acid + mometasone in clinical settings like intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations is not standard practice. This combination is specifically indicated for topical treatment of dermatological conditions.
Side Effects
Common Side Effects:
- Burning sensation
- Itching
- Irritation
- Dryness
- Redness at the application site
Rare but Serious Side Effects:
- Skin atrophy
- Telangiectasia (dilated blood vessels)
- Folliculitis
- Acneiform eruptions
- Allergic reactions (rash, difficulty breathing, swelling)
Contraindications
- Hypersensitivity to fusidic acid, mometasone, or any component of the formulation.
- Primary bacterial infections like tuberculosis or syphilis affecting the skin.
- Viral skin infections (e.g., herpes simplex, varicella).
- Rosacea.
- Acne.
- Perioral dermatitis.
Drug Interactions
- Interactions with other topical medications applied concurrently to the same area should be considered.
- Although systemic absorption is minimal, potential interactions with CYP3A4 inhibitors (e.g., itraconazole, ketoconazole) and some antibiotics (e.g., chloramphenicol) have been noted.
Pregnancy and Breastfeeding
Safety during pregnancy and breastfeeding hasn’t been definitively established. Use with caution and only if potential benefits outweigh the risks. Consult a doctor before using if pregnant or breastfeeding.
Drug Profile Summary
- Mechanism of Action: Fusidic acid: Inhibits bacterial protein synthesis. Mometasone: Binds to glucocorticoid receptors, reducing inflammation.
- Side Effects: Itching, burning, irritation, dryness, skin atrophy (with prolonged use).
- Contraindications: Hypersensitivity, primary bacterial/viral skin infections.
- Drug Interactions: CYP3A4 inhibitors, some antibiotics.
- Pregnancy & Breastfeeding: Use with caution; consult a physician.
- Dosage: Apply thinly twice daily, not exceeding two weeks.
- Monitoring Parameters: Observe for skin atrophy, local irritation, signs of infection.
Popular Combinations
Fusidic acid + mometasone is itself a combination product; additional combinations are not typical.
Precautions
- Avoid contact with eyes, nose, and mouth.
- Not for use on broken skin, open wounds, or under occlusive dressings unless directed by a physician.
- Do not use for diaper rash.
- Use cautiously in patients with diabetes or other medical conditions as mentioned earlier.
- Wash hands after application.
FAQs (Frequently Asked Questions)
A: Apply a thin layer to the affected area twice daily, usually for no longer than two weeks. Pediatric dosing should be determined by a physician.
Q2: Can I use this cream on my face?
A: Yes, but avoid contact with eyes, nose, and mouth.
Q3: How long does it take to see improvement?
A: You should see improvement within a few days, but complete the prescribed course even if symptoms resolve earlier.
Q4: What if I miss a dose?
A: Apply the missed dose as soon as you remember, but do not double the dose.
Q5: Can I use this cream for any skin infection?
A: No, this cream is specifically for bacterial infections complicating inflammatory skin conditions. It does not treat viral or fungal infections.
Q6: Is it safe to use this cream during pregnancy?
A: Consult your doctor before using this cream during pregnancy or breastfeeding.
Q7: Can this cream cause skin thinning?
A: Prolonged use of topical corticosteroids like mometasone can cause skin thinning. Follow your doctor’s instructions regarding duration of treatment.
Q8: What should I do if my condition doesn’t improve?
A: Consult your doctor if your condition doesn’t improve after a few days of treatment or if it worsens.
Q9: Can I use other topical medications with this cream?
A: Discuss with your doctor before using other topical medications concurrently to avoid potential interactions.
