13.10.1.1 Antibacterial preparations only used topically

Mupirocin

• Cream 2% (£5.26 = 15g)
• Ointment 2% (£15.00 = 15g)

Indications

• Bacterial skin infections

Dose

• Apply up to three times a day for up to 10 days

Notes

1. Mupirocin ointment and cream are not interchangeable - specify formulation required.
2. 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

• Infected burns
• Leg ulcers

Dose

• Burns: Apply daily with a sterile applicator
• Leg ulcers: Apply at least 3 times weekly

Notes

1. 250g and 500g pots of silver sulfadiazine cream should be discarded 24 hours after opening.

Flammacerium

• Cream 500g (unlicensed preparation)

Notes

1. Flammacerium cream is a 'single use item' and is only to be prescribed by a senior clinician experienced in treating burns
2. 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

• Infected eczema
  • Adults and children: Apply three times a day for 5-7 days
• Non-bullous impetigo
  • Adults and children: Apply three times a day for 5-7 days

Metronidazole

• Cream 0.75% (£12.35 = 50g)
• Gel 0.75% (click here for preferred brands)

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

1. There can be variation in the licensing of different medicines containing the same drug (refer to individual product SPC)
2. 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)