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13.10 ANTI-INFECTIVE SKIN PREPARATIONS

13.10 ANTI-INFECTIVE SKIN PREPARATIONS

13.10.1 Antibacterial preparations 

13.10.1.1 Antibacterial preparations only used topically
To reduce the development of resistance it is advisable to limit the choice of antibiotic used topically to one not used systemically. 
Whenever possible, swabs for bacterial examination should be taken before treatment is started. Mupirocin is generally restricted
to use in wounds that are MRSA positive.  
 
GREEN      Mupirocin 2% (Bactroban®) ointment / nasal ointment  
GREEN      Silver sulphadiazine 1% (Flamazine®) cream   
 

13.10.1.2.2 Preparations of antibacterials also used systemically

It is generally advised that topical antimicrobials are not used.  The exceptions to this are the use of metronidazole topically for 
acne rosacea, and in the management of malodorous wounds.  Topical fusidic acid should be reserved for impetigo where there
are very localised lesions only. 
In the presence of visible or proven infection, systemic antibiotics are to be used.  See antimicrobial guidelines.
 
GREEN      Fusidic acid 2% (Fucidin®) cream, ointment [see recommendations above]  
GREEN      Metronidazole (Anabact®) 0.75% gel  [see recommendations above] 
 

13.10.2 Antifungal preparations

Take scrapings, hair or nail clippings where possible before treatment is started. Local therapy is used when extent of infection is 
limited. Systemic therapy is required for widespread infections, or if topical treatment fails.  If treating pityriasis vesicolor and 
topical treatment fails, treat systemically with an azole antifungal (section 5.2). 
 
GREEN      Clotrimazole  cream 1%,  dusting powder 1%    
GREEN      Miconazole cream 2%       
GREEN      Terbinafine cream 1%     
 
For infected nails 
GREEN     Amorolfine nail lacquer 5% (Loceryl®) 
 
Other antifungals (for azole antifungals see section 5.2)  
GREEN      Terbinafine tablets 250mg        
 

13.10.3 Antiviral preparations

Indicated for treatment of labial and genital herpes simplex infections.
GREEN     Aciclovir cream 5% 
 

13.10.4 Parasiticidal preparations

Head lice 
Only treat those with living, moving lice present.  A course of treatment for head lice should be 2 applications of product 7 days 
apart to kill the lice emerging from any eggs that survive the first application. All affected household members should be treated 
simultaneously. 
 
Wet Combing
Head lice can be mechanically removed by combing wet hair meticulously with a plastic detection comb for at least 30 minutes 
over the whole scalp at 4-day intervals for a minimum of 2 weeks, and continued until no lice are found on 3 consecutive sessions. 
 
Dimeticone 
Hedrin (4% dimeticone) lotion is a non-insecticide preparation that coats head lice and interferes with water balance in lice by 
preventing the excretion of water.  It can be used from age 6 months, and has shown similar efficacy to phenothrin 0.5% liquid 
(70% vs. 75% cure rate).  As with the other insecticide treatments this is a pharmacy only medicine and treatment should follow 
the same regime as is laid out for those other products i.e. treatment is 2 applications 7 days apart. The contact time for this 
product is 8 hours or overnight.  One 50ml bottle should be sufficient for two applications on short hair. 
Refer to guidelines online here 
 
First (or Second) Line 
GREEN       Dimeticone lotion 4%, aqueous  
 
First (or Second) Line 
Use alcohol based preparations where possible.  Use aqueous liquid for those with asthma and severe eczema, children under 5
years and pregnant & lactating women.
GREEN      Malathion liquid 0.5%, aqueous  
GREEN      Malathion lotion 0.5%, alcoholic    
 
Crab Lice 
Permethrin or malathion are used to eliminate crab lice. An aqueous preparation should be applied, allowed to dry naturally and 
washed off after 12 hours. A second treatment will be needed after 7 days.  
 
Scabies 
Permethrin is effective for scabies.  
GREEN        Permethrin cream 5%