13.10.1 Antibacterial preparations

13.10.1.1 Antibacterial preparations only use topically

Mupirocin
  • Cream 2% (£5.26 = 15g)
  • Ointment 2% (£4.38 = 15g)

Indications

  • Bacterial skin infections

Dose

  • Apply up to 3 times daily 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 (£1.81 = 15g)

Indications

Dose

  • Apply 3–4 times daily
Metronidazole
  • Cream 0.75% (£9.88 = 40g)
  • Rozex® Gel 0.75% (£9.88 = 40g)
  • Metrogel® gel 0.75% (£22.63 = 40g)

Indications and dose

  • (Rozex®) Acute inflammatory exacerbation of rosacea, apply thinly twice daily
  • (Metrogel®) Malodorous fungating tumours, apply to clean wound 1–2 times daily and cover with non-adherent dressing

 

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