Adjunct to prophylaxis of infection in skin graft donor
sites and extensive abrasions
▶TO THE SKIN
▶Child:(consult product literature)
Adjunct to short-term treatment of infection in pressure
sores
▶TO THE SKIN
▶Child:(consult product literature)lUNLICENSED USENo age range specified by manufacturer.
lCONTRA-INDICATIONSNot recommended for neonates
lCAUTIONSG 6 PD deficiency
CAUTIONS, FURTHER INFORMATIONPlasma-sulfadiazine
concentrations may approach therapeutic levels withside-
effectsandinteractionsas for sulfonamides if large areas of
skin are treated.
lINTERACTIONS→Appendix 1 : silver sulfadiazine
lSIDE-EFFECTS
▶Common or very commonLeucopenia.skin reactions
▶Rare or very rareArgyria (following treatment of large
areas of skin or long term use).renal failure
SIDE-EFFECTS, FURTHER INFORMATIONLeucopenia
developing 2 – 3 days after starting treatment of burns
patients is reported usually to be self-limiting and silver
sulfadiazine need not usually be discontinued provided
blood counts are monitored carefully to ensure return to
normality within a few days.
lALLERGY AND CROSS-SENSITIVITYContra-indicated in
patients with sensitivity to sulfonamides.
lPREGNANCYRisk of neonatal haemolysis and
methaemoglobinaemia in third trimester.
lBREAST FEEDINGSmall risk of kernicterus in jaundiced
infants and of haemolysis in G 6 PD-deficient infants.
lHEPATIC IMPAIRMENTManufacturer advises caution if
significant impairment.
lRENAL IMPAIRMENTManufacturer advises caution if
significant impairment.
lMONITORING REQUIREMENTSMonitor for leucopenia.
lDIRECTIONS FOR ADMINISTRATIONApply with sterile
applicator.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Cream
EXCIPIENTS:May contain Cetostearyl alcohol (including cetyl and
stearyl alcohol), polysorbates, propylene glycol
▶Flamazine(Smith & Nephew Healthcare Ltd)
Sulfadiazine silver 10 mg per 1 gramFlamazine 1 % cream|
20 gramP£ 2. 91 | 50 gramP£ 3. 85 DT = £ 3. 85 |
250 gramP£ 10. 32 DT = £ 10. 32 | 500 gramP£ 18. 27 DT =
£ 18. 27ANTIBACTERIALS›OTHER
Mupirocin
lINDICATIONS AND DOSE
Bacterial skin infections, particularly those caused by
Gram-positive organisms (except pseudomonal
infection)
▶TO THE SKIN
▶Child:Apply up to 3 times a day for up to 10 dayslUNLICENSED USEMupirocin ointment licensed for use in
children (age range not specified by manufacturer).
Bactroban®cream not recommended for use in children
under 1 year.
lSIDE-EFFECTS
▶Common or very commonSkin reactionslPREGNANCYManufacturer advises avoid unless potential
benefit outweighs risk—no information available.
lBREAST FEEDINGNo information available.
lRENAL IMPAIRMENTManufacturer advises caution when
mupirocin ointment used in moderate or severe
impairment because it contains macrogols (polyethylene
glycol).lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Ointment
▶Mupirocin (Non-proprietary)
Mupirocin 20 mg per 1 gramMupirocin 2 % ointment|
15 gramP£ 12. 50 DT = £ 5. 26
▶Bactroban(GlaxoSmithKline UK Ltd)
Mupirocin 20 mg per 1 gramBactroban 2 % ointment|
15 gramP£ 5. 26 DT = £ 5. 26
Cream
EXCIPIENTS:May contain Benzyl alcohol, cetostearyl alcohol (including
cetyl and stearyl alcohol)
▶Bactroban(GlaxoSmithKline UK Ltd)
Mupirocin (as Mupirocin calcium) 20 mg per 1 gramBactroban
2 % cream| 15 gramP£ 5. 26 DT = £ 5. 26Retapamulin
lINDICATIONS AND DOSE
Superficial bacterial skin infection caused by
Staphylococcus aureusandStreptococcus pyogenes(if
resistant to first line topical antibacterials)
▶TO THE SKIN
▶Child 9 months–17 years:Apply twice daily for 5 days, to
be applied thinly, maximum area of skin treated 2 %of
body surface area, review treatment if no response
within 2 – 3 dayslCONTRA-INDICATIONSContact with eyes.contact with
mucous membranes
lSIDE-EFFECTS
▶UncommonContact dermatitis
lNATIONAL FUNDING/ACCESS DECISIONS
Scottish Medicines Consortium (SMC) Decisions
TheScottish Medicines Consortiumhas advised (March
2008 ) that retapamulin (Altargo®)isnotrecommended for
use within NHS Scotland for the treatment of superficial
skin infections.lMEDICINAL FORMS
No licensed medicines listed.2.2 Fungal skin infections
Other drugs used for Fungal skin infectionsGriseofulvin,
p. 379 .Hydrocortisone with clotrimazole, p. 743ANTIFUNGALS›IMIDAZOLE ANTIFUNGALS
Clotrimazole
lINDICATIONS AND DOSE
Fungal skin infections
▶TO THE SKIN
▶Child:Apply 2 – 3 times a daylCAUTIONSContact with eyes and mucous membranes
should be avoided
lINTERACTIONS→Appendix 1 : antifungals, azoles724 Infections of the skin BNFC 2018 – 2019
Skin13