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 |
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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 |
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 |
impetigo, second line use, where there are very localised lesions only. [Hydrogen peroxide cream 1% is recommended as |
first line treatment of impetigo]. 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 | |
vesicolor and treating pityriasis 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®) [Consider OTC/Self care] |
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Other antifungals (for azole antifungals see section 5.2) |
GREEN Terbinafine tablets 250mg |
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13.10.3 Antiviral preparations |
Indicated for treatment of labial and genital herpes simplex infections. |
GREEN Aciclovir cream 5% |
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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. |
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Scabies |
Permethrin is effective for scabies. |
GREEN Permethrin cream 5% |
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