| 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.
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Whenever possible, swabs for bacterial examination should be taken before treatment is started. Mupirocin is generally
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restricted to use in wounds that are MRSA positive.
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GREEN Mupirocin 2% (Bactroban®) ointment / nasal ointment
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GREEN Silver sulphadiazine 1% (Flamazine®) cream
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| Stimulan Rapid Cure [Consultant use only] |
| For use for bone and soft tissue infection in Diabetic Foot Clinic. Ready-mixed product is preferred product. |
| RED Stimulan Rapid Cure pre-mixed with gentamicin and vancomycin |
| RED Stimulan Rapid Cure - only to be used when pre-mixed product is unavailable or when smaller quantity required |
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| 13.10.1.2. 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
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impetigo, second line use, where there are very localised lesions only. [Hydrogen peroxide cream 1% is recommended as
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first line treatment of impetigo]. In the presence of visible or proven infection, systemic antibiotics are to be used.
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| See antimicrobial guidelines. |
GREEN Fusidic acid 2% (Fucidin®) cream, ointment [see recommendations above]
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GREEN Metronidazole (Anabact®) 0.75% gel [see recommendations above]
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| 13.10.2 Antifungal preparations |
Take scrapings, hair or nail clippings where possible before treatment is started. Local therapy is used when extent of
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| infection is limited. Systemic therapy is required for widespread infections, or if topical treatment fails. If | |
vesicolor and treating pityriasis topical treatment fails, treat systemically with an azole antifungal (section 5.2).
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GREEN Clotrimazole cream 1%, dusting powder 1%
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GREEN Miconazole cream 2%
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GREEN Terbinafine cream 1%
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For infected nails
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GREEN Amorolfine nail lacquer 5% (Loceryl®) [Consider OTC/Self care]
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Other antifungals (for azole antifungals see section 5.2)
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GREEN Terbinafine tablets 250mg
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| 13.10.3 Antiviral preparations |
Indicated for treatment of labial and genital herpes simplex infections.
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GREEN Aciclovir cream 5%
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| Back to Main Chapter |
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| 13.10.4 Parasiticidal preparations |
| NHS Lancashire and South Cumbria Scabies Operation Clinical Pathway - Click here |
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Head lice
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Only treat those with living, moving lice present. A course of treatment for head lice should be 2 applications of product 7
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days apart to kill the lice emerging from any eggs that survive the first application. All affected household members
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should be treated simultaneously.
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Wet Combing
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Head lice can be mechanically removed by combing wet hair meticulously with a plastic detection comb for at least 30
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minutes over the whole scalp at 4-day intervals for a minimum of 2 weeks, and continued until no lice are found on 3
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| consecutive sessions. |
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Dimeticone
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Hedrin (4% dimeticone) lotion is a non-insecticide preparation that coats head lice and interferes with water balance in lice
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by preventing the excretion of water. It can be used from age 6 months, and has shown similar efficacy to phenothrin
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0.5% liquid (70% vs. 75% cure rate). As with the other insecticide treatments this is a pharmacy only medicine and
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treatment should follow the same regime as is laid out for those other products i.e. treatment is 2 applications 7 days
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apart. The contact time for this product is 8 hours or overnight. One 50ml bottle should be sufficient for two applications
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on short hair. Refer to guidelines online here
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First (or Second) Line
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GREEN Dimeticone lotion 4%, aqueous
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First (or Second) Line
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Use alcohol based preparations where possible. Use aqueous liquid for those with asthma and severe eczema, children
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under 5 years and pregnant & lactating women.
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GREEN Malathion liquid 0.5%, aqueous
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GREEN Malathion lotion 0.5%, alcoholic
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Crab Lice
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Permethrin or malathion are used to eliminate crab lice. An aqueous preparation should be applied, allowed to dry
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naturally and washed off after 12 hours. A second treatment will be needed after 7 days.
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Scabies
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| See NHS Lancashire and South Cumbria Scabies Operation Clinical Pathway - Click here |
Permethrin is effective for scabies.
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GREEN Permethrin cream 5%
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