13.10.1.1 Antibacterial preparations only used topically
Mupirocin
- Cream 2% (£5.26 = 15g)
- Ointment 2% (£10.99 = 15g)
Indications
- Bacterial skin infections
Dose
- Apply up to three times a day for up to 10 days
Notes
- Mupirocin ointment and cream are not interchangeable - specify formulation required.
- Mupirocin should only be used on recommendation of Infection Control or Microbiology. Should be kept in reserve to avoid resistance developing and is particularly useful in treating MRSA.
The use of topical antimicrobial agents has long been discouraged, on the grounds that it carries a particular risk of selecting resistance. However, some topical antibacterial use is strongly defensible, for example:
- Use of sulphonamides with silver nitrate to prevent and treat burn wound infections
- Use of mupirocin to eliminate colonisation and superficial infections caused by MRSA. Nevertheless, mupirocin can be misused e.g. by being given as blanket treatment or prophylaxis.
Silver sulfadiazine
- Cream 1% (20g, 50g, 250g, 500g) (£3.85 = 50g)
Indications
Dose
- Burns: Apply daily with a sterile applicator
- Leg ulcers: Apply at least 3 times weekly
Notes
- 250g and 500g pots of silver sulfadiazine cream should be discarded 24 hours after opening.
Flammacerium
- Cream 500g (unlicensed preparation)
Notes
- Flammacerium cream is a 'single use item' and is only to be prescribed by a senior clinician experienced in treating burns
- For use in Plymouth Hospitals NHS Trust
13.10.1.2 Antibacterial preparations also used systemically
Fusidic acid
- Cream 2% 15g, 30g (£1.92, £3.59)
- Ointment 2% 15g, 30g (£2.68, £4.55)
Indications and dose
Metronidazole
Indications and dose
- Cream:
- Inflammatory papules, pustules and erythema of rosacea, Apply twice daily for 3–4 months.
- Gel:
- Acute inflammatory exacerbation of rosacea, apply thinly twice daily for 8-9 weeks
- Malodorous fungating tumours, apply to clean wound 1–2 times daily and cover with non-adherent dressing
Notes
- There can be variation in the licensing of different medicines containing the same drug (refer to individual product SPC).
- Where a preferred brand is recommended for a particular presentation, prescribing by brand helps ensure cost-efficient use of local NHS resources (see preferred brand link above).