fusidic acid and hydrocortisone

Action and Spectrum

Actions and spectrum: 

fusidic acid is an antibiotic with bacteriostatic action against gram-positive bacteria, including Staphylococcus aureus. It inhibits protein synthesis by binding to elongation factor G (EF-G) and preventing the translocation of ribosomes along the mRNA. hydrocortisone is a corticosteroid with anti-inflammatory and immunosuppressive properties.

It acts by inhibiting inflammatory mediators’ production and suppressing immune responses. The combination of fusidic acid and hydrocortisone provides both antibacterial and anti-inflammatory effects, making it useful in the treatment of certain skin conditions such as infected eczema. 

Drug Interaction

Adverse Reaction

Frequency defined 

Dermatitis (2%) 

Local irritation (2%)  

Frequency not defined 

acne rosacea 

burning sensation of skin 

hypertrichosis 

secondary skin infection 

subcutaneous atrophy 

xeroderma 

atrophic striae 

Dyschromia 

pruritus 

skin atrophy 

telangiectasia 

Hypersensitivity reaction 

Black Box Warning

Black Box Warning: 

There is no specific black box warning associated with the combination of fusidic acid and hydrocortisone 

Contraindication / Caution

Contraindication/Caution: 

Contraindication: 

• Hypersensitivity: Individuals with known hypersensitivity or allergic reactions to fusidic acid, hydrocortisone, or any other components of the formulation should not use the medication. 
• Viral infections: Topical use of corticosteroids like hydrocortisone may exacerbate viral infections such as herpes simplex, chickenpox, or measles. 
• Fungal or bacterial skin infections: The use of fusidic acid and hydrocortisone may be contraindicated in the presence of fungal or bacterial skin infections, as corticosteroids can worsen such infections or interfere with their treatment. 
• Tuberculosis: Systemic administration of corticosteroids may be contraindicated in patients with active or suspected tuberculosis due to the potential for reactivation or exacerbation of the infection.

Caution: 

• Systemic absorption: Depending on the formulation and application method, there may be a risk of systemic absorption of both fusidic acid and hydrocortisone. This can lead to potential systemic side effects associated with corticosteroids, such as adrenal suppression or Cushing’s syndrome. Caution is advised, particularly in patients who are at higher risk for systemic absorption, such as those with extensive dermatological lesions or compromised skin integrity. 
• Prolonged use: Prolonged or excessive use of topical corticosteroids, including hydrocortisone, can lead to skin atrophy, striae, telangiectasia, or other local side effects. The duration of treatment should be limited to avoid these potential adverse effects. 
• Infection risk: Topical corticosteroids can suppress immune responses and mask symptoms of infection. It is important to monitor for signs of bacterial, viral, or fungal infections during treatment. If an infection develops, appropriate antimicrobial therapy may be required. 
• Use in children: The use of corticosteroids in children should be carefully considered, as they may be more susceptible to systemic side effects. Close monitoring and appropriate dose adjustment based on age, weight, and treatment duration are recommended.

Comorbidities: 

• Infections: fusidic acid and hydrocortisone combination may need cautious use in individuals with known or suspected bacterial, viral, or fungal infections. The immunosuppressive effects of corticosteroids can potentially worsen or mask the symptoms of an existing infection. 
• Diabetes: Individuals with diabetes should be closely monitored when using fusidic acid and hydrocortisone, as corticosteroids can affect blood glucose levels and potentially interfere with diabetes management. 
• Skin conditions: The combination may require extra caution in individuals with skin conditions such as atopic dermatitis, eczema, or psoriasis. The use of corticosteroids can have varied effects on these conditions, and close monitoring is necessary to ensure optimal management. 
• Hypertension: Individuals with hypertension or other cardiovascular conditions should use fusidic acid and hydrocortisone with caution, as corticosteroids can have potential effects on blood pressure and fluid balance. 
• Ocular conditions: Individuals with pre-existing eye conditions such as glaucoma or cataracts may require cautious use of fusidic acid and hydrocortisone due to the potential ocular side effects associated with corticosteroid use. 

Pregnancy / Lactation

Pregnancy consideration: pregnancy category: unknown 

Lactation: excreted into human milk: unknown  

Pregnancy category: 

• Category A: well-controlled and Satisfactory studies show no risk to the fetus in the first or later trimester. 
• Category B: there was no evidence of risk to the fetus in animal studies, and there were not enough studies on pregnant women. 
• Category C: there was evidence of risk of adverse effects in animal reproduction studies, and no adequate evidence in human studies must take care of potential risks in pregnant women.   
• Category D: adequate data with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits. 
• Category X: Drugs listed in this category outweigh the risks over benefits. Hence these categories of drugs need to be avoided by pregnant women. 
• Category N: There is no data available for the drug under this category. 

Pharmacology

Pharmacology: 

fusidic acid is acts by inhibiting bacterial protein synthesis. It specifically targets and interferes with the function of bacterial elongation factor G (EF-G), preventing the elongation of the bacterial protein chain and inhibiting bacterial growth. fusidic acid primarily acts against Gram-positive bacteria, including Staphylococcus aureus. 

hydrocortisone, on the other hand, is a corticosteroid with anti-inflammatory and immunosuppressive properties. It acts by binding to glucocorticoid receptors, leading to the modulation of gene expression and the regulation of various cellular processes involved in inflammation and immune response. hydrocortisone helps to reduce inflammation, alleviate itching, and provide relief in skin conditions.  

Pharmacodynamics: 

fusidic acid exhibits its pharmacodynamic effects by inhibiting bacterial protein synthesis. It specifically targets and binds to elongation factor G (EF-G) in bacteria, preventing the release of EF-G from the ribosome and interfering with the translocation step of protein synthesis. This leads to the inhibition of bacterial growth. 

hydrocortisone, a corticosteroid, exerts its pharmacodynamic effects by binding to glucocorticoid receptors. Once bound, hydrocortisone modulates gene expression, resulting in various anti-inflammatory and immunosuppressive effects. It inhibits the production and release of pro-inflammatory cytokines, reduces the migration of inflammatory cells, and suppresses the immune response. 

When used in combination, fusidic acid and hydrocortisone work synergistically to treat bacterial skin infections with an inflammatory component. fusidic acid targets the bacterial infection by inhibiting protein synthesis, while hydrocortisone helps to reduce inflammation and alleviate associated symptoms.  

Pharmacokinetics: 

Absorption 

• fusidic acid: It is well absorbed after topical application to the skin, with minimal systemic absorption. 
• hydrocortisone: It can be absorbed through the skin, and the extent of absorption depends on factors such as the formulation and the integrity of the skin barrier. 

Distribution 

• fusidic acid: It distributes into the tissues and can penetrate well into the skin. 
• hydrocortisone: It is distributed widely throughout the body, including the skin. 

Metabolism 

• fusidic acid: It undergoes hepatic metabolism primarily by cytochrome P450 enzymes, CYP3A4. 
• hydrocortisone: It undergoes hepatic metabolism by various enzymes, including cytochrome P450 enzymes. 

Elimination and excretion 

• fusidic acid: It is primarily eliminated via the liver, with a small portion excreted unchanged in the urine and feces. 
• hydrocortisone: It is metabolized and eliminated through the urine, primarily as metabolites. 

Adminstartion

Administration: 

• Clean the affected area: Before applying the ointment or cream, gently clean and dry the affected area of the skin. 
• Apply a thin layer: Apply a thin layer of the cream or ointment to the affected area. gently rub it into the skin till it gets absorbed. 
• Follow the prescribed frequency: The frequency of application will depend on the specific instructions from your healthcare professional. It is typically applied two to three times a day but follow the recommended dosing schedule provided to you. 
• Do not cover with occlusive dressing: In most cases, it is not necessary to cover the treated area with a bandage or occlusive dressing. However, follow the instructions provided by your healthcare professional or on the product label. 
• Wash hands after application: After applying the cream or ointment, wash your hands thoroughly to avoid inadvertently spreading it to other areas of the body or transferring it to other people. 

Patient Information Leaflet

Patient information leaflet 

Generic Name: fusidic acid and hydrocortisone 

Pronounced: (fyoo-SID-ik AS-id-and- hye-droh-KOR-ti-zone)  

Why do we use fusidic acid and hydrocortisone? 

• Eczema: It can be used to reduce inflammation, itching, and redness associated with eczema. 
• Dermatitis: It may be prescribed for contact dermatitis or allergic dermatitis, which cause skin irritation, redness, and itching due to exposure to allergens or irritants. 
• Allergic reactions: It can help alleviate symptoms of allergic reactions on skin, such as itching, swelling, and redness. 
• Insect bites and stings: fusidic acid and hydrocortisone combination may be used to relieve itching and reduce inflammation. 
• Rashes: It can be used to treat various types of rashes, including rash caused by irritants, allergic reactions, or certain skin infections.