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13.10 Anti-infective Skin Preparations

       13.10.1 Antibacterial preparations
    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   
                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
    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]   
               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. 
                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.  
                Permethrin is effective for scabies.  
                GREEN        Permethrin cream 5%

     13.10.1 Antibacterial preparations Antibacterial preparations only used topically