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Fusidic acid in dermatology: An updated review
Abstract
Studies on the clinical efficacy of fusidic acid in skin and soft-tissue infections (SSTIs), notably those due to Staphylococcus aureus, are reviewed. Oral fusidic acid (tablets dosed at 250 mg twice daily, or a suspension for paediatric use at 20 mg/kg/day given as two daily doses) has shown good efficacy and tolerability. Similarly, plain fusidic acid cream or ointment used two or three times daily in SSTIs such as impetigo are clinically and bacteriologically effective, with minimal adverse events. Combination formulations of fusidic acid with 1% hydrocortisone or 0.1% betamethasone achieve excellent results in infected eczema by addressing both inflammation and infection. A new lipid-rich combination formulation provides an extra moisturizing effect. Development of resistance to fusidic acid has remained generally low or short-lived and can be minimized by restricting therapy to no more than 14 days at a time.
... ФК липофильна, однако натриевая соль свободно растворяется в воде, что позволяет производить лекарственные препараты в форме крема или мази [13]. ФК проникает в эпидермис подобно глюкокортикостероидам, создавая депо препарата в слое корнеоцитов Вестник дерматологии и венерологии. ...
... Показано, что ФК проникает даже в деваскуляризированные зоны и некротические ткани [26,27]. Препарат свободно проникает также и через корки и чешуйки, и, таким образом, достигается ускоренное развитие клинического эффекта [13]. ...
... Продемонстрирована высокая клиническая эффективность наружной терапии первичных и вторичных пиодермий ФК -при первичных пиодермиях она составила 100%. Это коррелирует с более ранними данными, показавшими высокую эффективность данного препарата [10,[13][14][15]. ...
Data regarding the role of cutaneous microbiome in physiological and pathological conditions, pharmacological properties of fusidic acid and its clinical use for the treatment of skin infections are presented in the article. Incidence of skin infections in children treated in children's city polyclinic №1 of Izhevsk city through 2019-2022 are analyzed. Outcomes of the treatment of these patients with topical fusidic acid preparations are presented. Due to high activity against typical cutaneous bacterial pathogens including MRSA strains of S. aureus, favorable safety profile and pharmacokinetic profile when topically applied along with low resistance of the key pathogens fusidic acid preparations are the first line treatment of primary and secondary pyodermas.
... Fusidic acid has an inhibitory effect on the protein synthesis of Gram-positive bacteria. Initially isolated in 1962 from Fusidium coccineum, fusidic acid was subsequently extracted from Mucor ramannianus and Isaria kogana [36,37]. Currently, biotechnological methods are obtained to derive fusafungin from species such as Calcarisporium arbuscula, Fusidium coccophilum, and Mortierella ramanniana [36]. ...
... This antibiotic can be used in the form of creams and ointments for the topical treatment of infections such as impetigo, boils, inflammation of sweat glands and hair follicles, atrophy, acne vulgaris, and infections caused by the genus Staphylococcus spp. [37,38]. Of significance, fusidic acid can permeate intact skin, with the extent of penetration influenced by factors such as antibiotic exposure duration and skin condition. ...
... While it is primarily excreted through the bile, a minor portion is eliminated unchanged in the urine [39]. While these compounds are not typically directly utilized in cosmetics due to their medical nature, they do exhibit effectiveness against pathogens responsible for skin diseases, such as S. aureus and Staphylococcus epidermidis [37]. ...
The phenomenon of drug resistance in micro-organisms necessitates the search for new compounds capable of combating them. Fungi emerge as a promising source of such compounds as they produce a wide range of secondary metabolites with bacteriostatic or fungistatic activity. These compounds can serve as alternatives for commonly used antibiotics. Furthermore, fungi also accumulate compounds with antiviral activity. This review focuses on filamentous fungi and macrofungi as sources of antimicrobial compounds. The article describes both individual isolated compounds and extracts that exhibit antibacterial, antifungal, and antiviral activity. These compounds are produced by the fruiting bodies and mycelium, as well as the biomass of mycelial cultures. Additionally, this review characterizes the chemical compounds extracted from mushrooms used in the realm of cosmetology; specifically, their antimicrobial activity.
... 9 In small case series, fusidic acid (FA) has been proven to have antimicrobial and anti-inflammatory properties. 10 The antimicrobial spectrum includes staphylococci and corynebacteria, which were detected in early and late HS lesions. 11 This retrospective cohort study aimed to evaluate treatment efficacy, identify predictors of therapy response, and assess the long-term safety of oral fusidic acid therapy in mild-to-moderate HS patients. ...
... FA inhibits bacterial protein synthesis and brings along several pharmacokinetic advantages over tetracyclines, clindamycin, or rifampicin, for example, its high bioavailability of 90% and high tissue availability. 10 shows great effectiveness against those gram-positive bacteria with no resistance described so far. ...
Background
Hidradenitis suppurativa (HS) is a debilitating inflammatory skin disease. Tetracyclines are one of the few therapeutic options recommended for mild‐to‐moderate disease. This study aimed to investigate the efficacy of systemic fusidic acid's (FA) effectiveness in treating HS.
Methods
This retrospective study analyzed 55 FA therapy cycles (TC, average weekly dose: 6409 mg; range: 5250–9800 mg; 2–12 weeks) in 49 patients. The outcome was evaluated using the Physician's Global Assessment (PGA) scale. Therapy response was defined as any reduction of inflammatory activity without the occurrence of flares. We also characterized adverse events and investigated predictors for treatment success. Results were compared to a matched control group receiving doxycycline.
Results
FA treatment (55 treatment cycles (TC); male: 45.5%; female: 54.5%) showed an overall response rate of 70.9% (39 TC). No worsening was observed. Significantly higher response rates were observed in females (83.3%, P = 0.026) and Hurley I (90.9%, P = 0.008). After multivariate adjustment, higher response rates were associated with the Hurley grade ( P = 0.046) but not with gender ( P = 0.0174). Adverse reactions (21.8% gastrointestinal symptoms) occurred in 27.3% (15 TC) and 46.7% within the first 4 weeks. Similar results were observed in the doxycycline control group (overall response rate: 76.4%).
Conclusion
Oral FA is safe and improves symptoms in most patients. HS patients could benefit from oral FA treatment, especially in case of contraindications or resistance to tetracyclines.
... Additionally, fusidic acid presents a lower risk of resistance even in MRSA strains, a common pathogen in skin infections and infected atopic dermatitis. Combination formulations of fusidic acid with 1% hydrocortisone or 0.1% betamethasone has been shown to achieve excellent results in infected eczema [32]. These lipid-rich formulations help to create an extra moisturizing effect on the skin, and the development of resistance to fusidic acid can be further minimized by restricting therapy to no more than 14 days at a time [32]. ...
... Combination formulations of fusidic acid with 1% hydrocortisone or 0.1% betamethasone has been shown to achieve excellent results in infected eczema [32]. These lipid-rich formulations help to create an extra moisturizing effect on the skin, and the development of resistance to fusidic acid can be further minimized by restricting therapy to no more than 14 days at a time [32]. ...
Many indications in dermatology can be effectively managed with topical antibiotics, including acne vulgaris, wound infections, secondarily infected dermatitis, and impetigo. Dermatologists must be familiar with the wide spectrum of topical antibiotics available, including indications, mechanisms of action, adverse events, and spectra of activity. Dermatologists must also keep antibiotic resistance in mind when utilizing these medications. Due to the widespread use of topical antibiotics and their importance in dermatology, a literature review was performed using a systematic search of PubMed and Google Scholar with the terms topical antibiotics, skin infections, dermatology, antimicrobials, and inflammatory dermatoses to identify English-language articles published between 1965–2022 from any country. Relevant publications were manually reviewed for additional content. The following literature review will summarize the common topical antibiotics used in dermatology.
... Комбинации фузидовой кислоты с бетаметазоном или гидрокортизоном применимы при лечении вторично-инфицированных дерматозов с хроническим течением [31]. Фузидовая кислота липофильна, однако натриевая соль свободно растворяется в воде, что позволяет производить лекарственные препараты в форме крема или мази [34]. Фузидовая кислота проникает в эпидермис подобно глюкокортикостероидам, создавая депо препарата в слое корнеоцитов [31]. ...
... Препарат свободно проникает также и через корки и чешуйки. Таким образом, достигается ускоренное развитие клинического эффекта [34]. ...
... aureus and Staphylococcus epidermidis [118]. ...
Fungi, which are diverse microorganisms, have gained attention for their potential use in developing safe and effective drugs. This review examines the different applications and therapeutic benefits of fungal extracts in the pharmaceutical industry. Fungal metabolites, which are bioactive and have a diverse structure, offer many promising drug development and discovery opportunities. The review provides an in-depth analysis of various fungal species and their bioactive compounds, highlighting their pharmacological properties and mechanisms of action. Additionally, the ecological significance of these fungal products is considered, emphasizing sustainable practices in drug development. The review critically assesses recent research findings and clinical trials, providing insight into fungal-derived drugs' efficacy and safety profiles. The potential challenges and future directions of harnessing fungal extracts as safe and effective drugs are also discussed. In summary, this comprehensive review consolidates current knowledge on the potential benefits of fungal extract products in drug development. The exploration of fungal metabolites as sources of novel therapeutic agents shows promise for advancing pharmaceutical science toward more sustainable and eco-friendly practices.
... Mupirocin is commonly used for nasal decolonization of S. aureus (Allport et al., 2022). Fusidic acid is a narrow-spectrum antibiotic that readily penetrates normal, damaged, and avascular skin, making it valuable for treating infections in deeper skin layers (Schöfer and Simonsen, 2010). To prevent the development of antimicrobial resistance, the use of alternatives to topical fusidic acid and mupirocin is recommended, even when MRSA is localized (Brown et al., 2021). ...
Ethnopharmacological relevance
Paulownia tomentosa Steud. (P. tomentosa) is a medium-sized tree traditionally used in Chinese folk medicine for the treatment of infectious diseases. It is a rich source of prenylated phenolic compounds that have been extensively studied for their promising biological activities.
Aim of the study
Due to the increasing development of antibiotic resistance, our study investigated plant-derived natural products from the fruits of P. tomentosa that could control Staphylococcus aureus infections with novel targets/modes of action and reduce antimicrobial resistance.
Materials and methods
The ethanolic extract was fractionated and detected by liquid chromatography. The antistaphylococcal effects of the plant formulations were studied in detail in vitro by various biological methods, including microdilution methods for minimum inhibitory concentration (MIC), the checkerboard titration technique for synergy assay, fluorescence measurements for membrane disruption experiments, autoinducer-2-mediated bioassay for quorum sensing inhibition, and counting of colony-forming units for relative adhesion. Morphology was examined by transmission electron microscopy.
Results
Total ethanolic extract and chloroform fraction showed MICs of 128 and 32 μg/ml, respectively. Diplacol, diplacone, and 3′-O-methyl-5′-hydroxydiplacone inhibited S. aureus growth in the range of 8–16 μg/ml. Synergistic potential was shown in combination with mupirocin and fusidic acid. The ethanolic extract and chloroform fraction destroyed cell membranes 91.61% and 79.46%, respectively, while the pure compounds were less active. The ethanolic extract and pure compounds reduced the number of adhered cells to 47.33–10.26% compared to the untreated control. Five tested plant formulations, except diplacone, inhibited quorum sensing of S. aureus. Transmission electron microscopy showed deformation of S. aureus cells.
Conclusions
The products from the fruit of P. tomentosa showed antimicrobial properties against S. aureus alone and in combination with antibiotics. By affecting intracellular targets, geranylated flavonoids proposed novel approaches in the control of staphylococcal infections.
... Side effects of povidone include hypersensitive reactions like rashes and allergies and it should not be used in patients with thyroid disease, hepatic or renal insufficiency and also has the risk of systemic absorption in infants [17]. Fusidic acid causes localized skin reactions like allergies at the site of application [18]. Alternative traditional healing strategies include herbal drugs, which are known to contain a good amount of phytochemicals that promote wound healing by stimulating cell proliferation and regeneration [19]. ...
As synthetic medications have various limitations and side effects in wound treatment, alternatively active wound dressing material could be designed by incorporating natural extracts. Electrospun fibers infused with plant extract can act as an active wound dressing material to speed up the process of wound healing. In this connection, the wound-healing efficacy of an Indian traditional drug Morinda tinctoria was reported earlier, but not yet explored as a natural active ingredient in electrospun fibers. The present work focused on preparing the extracts of M. tinctoria leaf and analyzing their yield, total phenolic concentration (TPC) and GC–MS phytochemical profile. The safety of methanol extract was studied in PBMC cells through MTT and live/dead assays and also TNF-α & IL-6 levels were quantified. Electrospinning of M. tinctoria-infused PHBV fiber mat was developed and characterized through SEM, FT-IR and TG–DTA. Results indicated that the methanol extract has a greater yield (2.47%) and TPC (4260.72 mg/L) when compared to other solvent extracts due to the presence of high polar molecules in M. tinctoria. GC–MS study revealed the phytochemicals such as coumarin and methylanthraquinone in the methanolic extract. MTT assay and live/dead staining revealed that the M. tinctoria extract was safe with 99% cell viability with intact cell wall. M. tinctoria induced the levels of TNF-α (328.75 pg/mL) and IL-6 (1357.14 pg/mL), which could improve the migration and proliferation of fibroblasts during wound healing. Development of M. tinctoria-infused fiber mat was optimized with 12% polymer concentration, 18 kV voltage, 0.01 mL/min flow rate and 14 cm tip to collector distance. SEM analysis of M. tinctoria-infused fiber mat revealed bead-less smooth fibers of 1.19 ± 0.15 µm diameter and 0.024 ± 0.003 µm pore size. FT-IR spectra revealed functional groups such as phenols, amines and alkanes in extract-incorporated fibers. A drop in temperature (457 °C) was noticed in M. tinctoria-infused fiber mat when compared to the control (595 °C), which indicates the degradation of organic matters in the fiber mat. M. tinctoria-infused fiber mat could be applied as wound dressing material after conducting suitable animal experiments.Graphical abstract
... There were no significant differences in pain between the two groups, but we found more subjects with VAS but zero pain in the intervention group, which may be a positive effect from fusidic acid despite having no anti-inflammatory actions [32]. Topical application of fusidic acid 2% cream for 7-14 days was considered adequate to resolve bacterial infections that cause inflammation, thus reducing overall inflammation and pain in most subjects in the intervention group. ...
Introduction:
Scabies is caused by Sarcoptes scabiei var hominis, often causing secondary bacterial infections, especially by Streptococcus pyogenes and Staphylococcus aureus. Permethrin 5% cream is the first-line of treatment that is recommended, combined with Fusidic acid 2% cream as the first-line topical antibiotic. We investigated the efficacy of a combination of permethrin 5% cream and fusidic acid 2% cream for the treatment of impetiginized scabies.
Methodology:
A double-blind, randomized clinical trial was organized at two Islamic boarding schools in Bogor, West Java, Indonesia. Forty subjects were randomly allocated into the intervention group (permethrin 5% and fusidic acid 2%; n = 20), and the control group (permethrin 5% and placebo; n = 20). Treatment efficacy was determined through the visual analogue scale (VAS) for pruritus and pain, and by examining bacterial cultures.
Results:
Treatment efficacy in the intervention group was higher than in the control group on day 7 (80% vs. 35%) and day 14 (95% vs 35%, p ≤ 0.001, RR 2.714) with decreasing VAS for pruritus (p = 0.04) and pain (p = 0.035). The most common bacterium was Staphylococcus aureus. Some minor adverse effects such as itch and heat occurred temporarily.
Conclusions:
Treating impetiginized scabies with permethrin 5% and fusidic acid 2% cream is more effective than treating with only 5% premethrin. The most common bacterium causing secondary infection in impetiginized scabies is Staphylococcus aureus.
... Fusidic acid is one such topical antibiotic which, despite having a narrow antibacterial spectrum against Gram-positive bacteria, has a high activity against Staphylococcus aureus (S. aureus), a commonly known skin pathogen (Bishop and Howden, 2007). Fusidic acid treatment has earned significant interest in the last decade due to its potential role in combat against superficial skin and soft tissue infections (Schöfer and Simonsen, 2010). There are different topical formulations available for fusidic acid and one such is Fucidin® cream which is widely marketed and used. ...
Topical antibiotics are a key component in the management of mild to moderate skin and soft tissue infections. There are however concerns about the emerging bacterial resistance against topical antibacterial agents such as fusidic acid, due to the prolonged treatment period of its marketed dosage forms. Improving the efficacy of topical formulations could potentially shorten the treatment period and avoid the resistance growth. To provide a more effective drug delivery, a water-free lipid-based formulation system (AKVANO®) which can be applied by spraying, has been developed. In the current paper, different formulations containing sodium fusidate were evaluated for their in vitro skin permeability using artificial skin mimicking membranes and antibacterial properties using ex vivo and in vivo skin wound infection models. The novel formulations containing sodium fusidate showed a much higher skin permeation (up to 60% of nominal amount) than the commercially available Fucidin cream (3%). These formulations also gave a significantly stronger antibacterial effect than Fucidin cream showing a clear dose-response relationship for the sodium fusidate content. A spray product based on the described formulation technology would therefore require a shorter treatment time and thereby lower the risk for the development of bacterial resistance. Spray administration of these formulations provides an even layer on the skin surface from which the solvent quickly evaporates and thereby facilitates a non-touch application where no rubbing is required.
... 3 Fusidic acid, employed for the treatment of superficial and systemic disease caused by staphylococci, is a valuable alternative to vancomycin for the infections caused by multi-drug resistant Staphylococci, especially the infection of methicillin-resistant Staphylococcus aureus. [4][5][6] But there is a concern that there is a significant trend towards increased FA resistance among Staphylococci with increased duration of use, which is an even greater problem for limiting our therapeutic options. 1,7 Fusidic acid inhibits elongation factor G (EF-G) release from ribosomes and eventually blocks the synthesis of bacterial proteins. ...
Purpose:
Fusidic acid (FA), a potent steroidal antibiotic, is used topically to treat skin and soft tissue infections (SSTIs) caused by Staphylococci. The aim of this study is to report the prevalence of fusidic acid resistance among Staphylococcus epidermidis clinical isolates from a tertiary hospital in Wenzhou, east China.
Methods:
The antibiotic susceptibility of S. epidermidis isolates was determined by disc diffusion method and agar dilution method. Then, FA-resistant S. epidermidis isolates were characterized by multi-locus sequence typing, SCCmec typing and pulsed-field gel electrophoresis.
Results:
In the present study, the 55 (7.7%) FA-resistant S. epidermidis among 711 S. epidermidis clinical isolates were isolated from different parts of 53 patients. Fifty-five FA-resistant S. epidermidis isolates with FA MIC values ranged from 4 to 32 μg/mL. Among them, 50 (90.9%) were identified as methicillin-resistant Staphylococcus epidermidis (MRSE), in which mecA were positive. Meanwhile, the positive rates of fusB and fusC genes among FA-resistant S. epidermidis isolates were 85.5% (47/55) and 7.3% (4/55), respectively. All 55 isolates mentioned above were susceptible to vancomycin. More than 50% of FA-resistant isolates were resistant to non-β-lactam antimicrobials including erythromycin (80.0%, 44/55), clindamycin (65.5%, 36/55), ciprofloxacin (63.6%, 35/55) and sulfamethoxazole (63.6%, 35/55). A total of 14 sequence types (STs) were identified among the 55 FA-resistant S. epidermidis isolates, of which, ST2 (24/55, 43.6%) was the most predominant type. And the eBURST analysis showed that CC2, CC5 and CC247 accounted for 43.6% (24/55), 27.3% (15/55) and 14.5% (5/55), respectively. Meanwhile, a total of four SCCmec types (I, III, IV, V) were identified among the 55 FA-resistant S. epidermidis. Furthermore, the pulsed field gel electrophoresis divided the 55 isolates into 20 types, namely A-T. Q-type strains were most prevalent, accounting for 30.9% (17/55).
Conclusion:
Taken together, the dissemination of S. epidermidis ST2 clone with FA resistance can cause trouble in controlling S. epidermidis infections.
... Дополнительное введение к терапии топическими ГКС антибиотиков повышает эффективность лечения у больных осложненных форм экземы и АД, при этом разрешение клинических симптомов отмечается на 7-й день применения комбинированных ГКС и коррелирует с уменьшением титров бактерий [13,14]. Монотерапия топическими ГКС также снижала колонизацию кожи больных, но на более поздних сроках лечения [13]. ...
The article covers issues related to the application of topical antibacterial drugs for the treatment of pyodermic skin diseases. The author describes mechanisms of action and advantages of the topical form of antibiotics and GCS for the topical treatment of pyodermas. The article substantiates indications for the administration of topical GCS drugs in a combination with antibacterial drugs. The efficacy and safety of antibacterial and combination topical drugs such as Neomycin, Oxycort and Polcortolon TC in the form sprays for the treatment of pyodermas and complicated forms of chronic dermatosis.
... The antibiotic exhibits excellent activity against S. aureus including MRSA (Fernandes 2016). The utility of fusidic acid (2%) in the treatment of impetigo has been well reported (Koning et al. 2002;Wilkinson 1998;Schofer and Simonsen 2010). Though mupirocin and fusidic acid have been in use for the years in treating MRSA impetigo, the rise in the resistance to these agents is also in reports (Patel, Gorwitz, and Jernigan 2009;Poovelikunnel, Gethin, and Humphreys 2015;Antonov et al. 2015;Dobie and Gray 2004;Brown and Thomas 2002). ...
Methicillin-Resistant Staphylococcus aureus (MRSA) became a major public health concern worldwide. The increase in the prevalence of antibiotic resistant pathogens, the limited efficacy and the adverse events associated with antibiotics have urged the development of complementary and alternative methods to treat Staphylococcus aureus (S. aureus) infections. This chapter provides a compact overview of the feasibility and clinical impact of novel therapies, with a focus on monoclonal antibodies (mAbs), vaccines, bacteriophages, liposomes and nanotechnology, photodynamic therapy (PDT), homeopathy and botanical medicine. Clinical trials with mAbs carried out in subjects with staphylococcal infections demonstrated that the majority failed to prove the efficacy and only a few remain in clinical development. Vaccines targeting S. aureus have recently been tested in clinical trials and although the results seem promising, there is currently no vaccine which has proven to be clinically effective. Several case studies have demonstrated the use of bacteriophages to treat infections caused by S. aureus. Although this kind of treatment demonstrated to be safe and effective, trials involving a larger population are necessary prior to confidently implement bacteriophages into clinical use. The potential use of liposomal compounds for the treatment of staphylococcal infections and to encapsulate antimicrobial agents as delivery methods, has recently emerged. Results showed that the application of liposomes improves the stability of antimicrobial agents and extends the length of activity, being a promising formulation for bacteria targeted delivery and immune system defense. Antibacterial PDT is a new non-antibiotic treatment strategy for a variety of drug-resistant bacteria including MRSA. Findings on recent studies suggest that PDT can effectively inhibit MRSA by damaging cell membrane, cytoplasm, proteins and nucleic acid. The study of plant extracts with antimicrobial activity allows the identification of active molecules and their mechanism of action, which increases the likelihood of new antimicrobial drugs development or their use in association with known antibiotics to enhance antimicrobial activity. Finally, homeopathic treatment may improve the clinical condition of patients, reduce the need for conventional antimicrobial agents and decrease the relapse rate of infection. Promising results have been obtained with the use of Belladona and MRSA isotherapic to inhibit MRSA growth in vitro, suggesting that this phenomenon was not due to bacterial cell death, but rather to a marked decrease in its growth rate, which probably make the bacteria more sensitive to oxacillin. As discussed in this chapter, there are several promising new complementary and alternative therapeutics towards MRSA that may be successfully used in combination with the available conventional antibimicrobial treatments.
... Translation EF-G interacts consecutively with the ribosome during polypeptide synthesis (Salama et al., 2013). The conventional topical formulations of FA fail to penetrate across the wound eschar leading to sub-optimal therapeutic efficacy and moreover, it has to be applied 2-3 times daily (Schöfer and Simonsen, 2010). ...
The objective of the present research was to examine the possible usage of microemulsion based gel for fusidic acid (FA) dermal application as burn wound treatment. During the preparation of microemulsion, ethyl oleate as oil phase, tween 80 as a surfactant, ethanol as co-surfactant, water as aqueous phase were used. The prepared microemulsions were evaluated for clarity, pH, viscosity and FA content. Moreover, stability, sterility, antibacterial activity, in vitro release of the formulations were also evaluated. The results showed that the FA loaded microemulsion and microemulsion based gel formation and characteristics were related to many parameters of the components. The performed optimized microemulsion-based gel showed good stability over a period of 3 months. The antibacterial activity of microemulsion-based gel was found to be comparable with marketed cream. RAW 264.7 macrophages were used to determine cell viability (MTT assay) and nitric oxide production. MBG and FA-MBG significantly inhibit the production of the inflammatory mediator NO in LPS-stimulated RAW 264.7 cells in a concentration-dependent manner. The wound healing property was evaluated by histopathological examination and by measuring the wound contraction. The % of wound area in rats treated with FA (2%) loaded microemulsion based gel ranged from 69.30% to 41.39% in the period from 3 to 10 days. In conclusion, FA loaded microemulsion based gel could be offered as encouraging strategy as dermal systems for the burn wound treatment.
... They also might contain the gene fusC encoding fusidic acid resistance [12,13]. Fusidic acid [14,15] is a steroid antibiotic known since the 1960s. It is frequently used in topical preparations, i.e., ointments, for the treatment of skin and soft tissue infections caused by S. aureus. ...
Fusidic acid is a steroid antibiotic known since the 1960s. It is frequently used in topical preparations, i.e., ointments, for the treatment of skin and soft tissue infections caused by Staphylococcus aureus. There is an increasing number of methicillin-resistant S. aureus (MRSA) strains that harbour plasmid-borne fusB/far1 or fusC that is localised on SCC elements. In this study we examined a series of related CC30-MRSA isolates from the Arabian Gulf countries that presented with SCCmec elements and fusC, including a variant that—to the best of our knowledge—has not yet formally been described. It consisted of a class B mec complex and ccrA/B-4 genes. The fusidic acid resistance gene fusC was present, but contrary to the previously sequenced element of HDE288, it was not accompanied by tirS. This element was identified in CC30 MRSA from Kuwait, Saudi Arabia and the United Arab Emirates that usually also harbour the Panton-Valentin leukocidin (PVL) genes. It was also identified in CC8 and ST834 isolates. In addition, further CC30 MRSA strains with other SCCmec VI elements harbouring fusC were found to circulate in the Arabian Gulf region. It can be assumed that MRSA strains with SCCmec elements that include fusC have a selective advantage in both hospital and community settings warranting a review of the use of topical antibiotics and indicating the necessity of reducing over-the-counter sale of antibiotics, including fusidic acid, without prescription.
... Fusidic acid is a quite effective in controlling of infections when used topically. 9 The crust present over the nasal septum usually harbors Gram-positive cocci which are responsible for frequent infections leading to repeated epistaxis. Fusidic acid has good Gram-positive coverage. ...
Aim
To establish fusidic acid ointment in the treatment of recurrent epistaxis in children as a local antiseptic.
Materials and methods
It was a retrospective study and a total of 184 pediatric patients’ data were analyzed. Ninety-seven patients were found to be fitting in selection criteria. The time of presentation, number of episodes, treatment received, and follow-ups were noted. Results were confirmed over the phone.
Results
Ninety-five patients had simple bleed and were managed on outpatient treatment with fusidic acid ointment and saline nasal drops, while two required admission and underwent electrocautery of offending vessel. Out of the 95 patients, 10 had initial failure of treatment in the 1st month, but with continued treatment were subsequently treated. Fifteen of these 95 had episodes in the next season. The incidence of bleeding was more in summers than winters in children.
Conclusion
Fusidic acid ointments are safe and effective in the treatment of recurrent epistaxis in children. Clinical significance: The effectivity of fusidic acid in epistaxis has never been studied. This study can establish it as an antiseptic ointment in the treatment of recurrent epistaxis.
How to cite this article
Khandelwal G, Pathak S, Sharma M. Fusidic Acid Ointment in Treatment of Recurrent Epistaxis in Children. J Postgrad Med Edu Res 2016;50(4):194-196.
... 51 Comparing with gentamicin and mupirocin, fusidic acid has a higher minimum inhibitory concentration in the deeper layers of the skin. In view of these considerations, the use of fusidic acid in HS lesions can be useful for Hurley stage I. 51,52 Other topical antibiotics There are not enough studies to support the use of gentamicin or erythromycin in HS. Some studies evaluated the use of gentamicin for the postoperative period with the aim of assessing the rates of recurrence and local complications. ...
Hidradenitis suppurativa is a chronic immune mediated disease of universal distribution that causes great damage to the quality of life of the affected individual, whose prevalence is estimated at 0.41% in the Brazilian population. The objective of this work was update on physiopathogenesis, diagnosis and classification of hidradenitis suppurativa and to establish therapeutic recommendations in the Brazilian reality. It was organized as a work group composed of eight dermatologists from several institutions of the country with experience in the treatment of hidradenitis suppurativa and carried out review on the topic. Recommendations were elaborated and voted by modified Delphi system and statistical analysis of the results was performed. The Brazilian consensus on the clinical approach of hidradenitis suppurativa had the support of the Brazilian Society of Dermatology.
... The antimicrobial activity of FA is specifically active for eradicating skin pathogens like Methicillin-resistant S. aureus and other wound infections. However, the currently available topical formulations of FA fail to penetrate across the wound eschar leading to sub-optimal therapeutic efficacy [47]. Thus, the developed FA loaded in situ gels offer a safer and promising solution in wound healing effect. ...
... Moreover, it is the empirical therapy, prescribed for impetigo and cost-effective. 11 A study showed that topical fusidic acid and mupirocin in staphylococcal skin infections had shown little difference in clinical outcome. 12 To this purpose, we compared the safety, effectiveness and adherence to treatment of fusidic acid with retapamulin in primary impetigo in a randomised open-label parallel group study. ...
Background: Impetigo is a contagious bacterial skin infection that affects both adults and children. Topical antibacterials such as mupirocin and fusidic acid are the most commonly used in both primary and secondary impetigo. Clinical trials have shown high efficacy of retapamulin in the treatment of secondary impetigo. However, its use in primary impetigo is limited. To this purpose, we compared the safety, efficacy and adherence to treatment of fusidic acid with retapamulin in primary impetigo.Methods: A total of 50 patients with a clinical diagnosis of primary impetigo, between 2-12 years of age, having <10 lesions, 3/5 signs and symptoms, skin infection rating score ≥4 and pus score ≥ one were involved. Patients who were having secondary impetigo leions were excluded. Twenty-five patients received 2% fusidic acid cream three times a day, and the remaining 25 patients received 1% retapamulin ointment two times a day for seven days. Skin Infection Rating Scale (SIRS) was used to assess the severity of disease at baseline and end of treatment. Clinical success was considered when SIRS score of zero each for pus, crust and pain and 0/1 each for erythema and itching. Clinical failure is a SIRS score of ≥1 for pus.Results: Baseline disease characteristics such as a number of lesions, the severity of disease (SIRS) and pus scores were statistically similar between the two groups. The clinical improvement observed with both fusidic acid and Retapamulin (20/25, 80%) and (21/25, 84%) treatments was not statistically different (p>0.05). Both drugs were well tolerated.Conclusions: Both fusidic and retapamulin showed similar clinical success in patients with primary impetigo. Since fusidic acid has anti-inflammatory property and its treatment is cost-effective, it can be considered as first-line treatment and retapamulin in fusidic acid-resistant impetigo.
... Fusidic acid (FA) is a valuable alternative to van- comycin for infections caused by multi-drug resistant staphylococci, especially MRSA infections (8)(9)(10). However, there is a significant trend towards increased FA resis- tance among staphylococci with increased duration of use. ...
Background: In the recent decades, mupirocin and fusidic acid (FA) have become important antimicrobial agents for skin and soft tissue infections (SSTIs) and the eradication of staphylococci colonization. Objectives: The present study aimed at determining the role of mupirocin and FA resistance in controlling Staphylococcus epidermidis infections and eradication of staphylococci colonization. Methods: This study was conducted between January 2012 and December 2015, at a tertiary hospital in Wenzhou, east China, on 711 S. epidermidis clinical isolates collected consecutively from various specimens of inpatients. Polymerase chain reaction (PCR) and DNA sequencing were used to identify mupA conferring high-level mupirocin resistance and fusA mutations. Multi-locus sequence typing (MLST) based on nucleotide sequencing of seven housekeeping genes revealed distinct related clones of methicillin-resistant S. epidermidis (MRSE), as clinically significant isolates. Results: Twelve FA-resistant S. epidermidis clinical isolates were positive for fusB, while only one was positive for fusC. All six S. epidermidis isolates with low-level mupirocin resistance were negative for mupA. However, 23 (35.38%) of 65 isolates with high level of resistance to mupirocin were found to carry this gene. Surprisingly, among 31 isolates with both mupirocin and FA resistance, only two were positive for fusB and only six were positive for mupA. More than 50% of the resistance for 71 mupirocin-resistant isolates and 56 FA-resistant isolates to non β-lactam included erythromycin, clindamycin, ciprofloxacin, gentamicin and trimethoprim-sulfamethoxazole. Among 31 S. epidermidis isolates with both mupirocin and FA resistance, 15, three, and two belonged to ST2, ST466, and ST23, respectively. ST125 and ST130 were found in one isolate, each. All 15 ST2 S. epidermidis isolates were MRSE with high-level resistance to mupirocin (MICs > 256 mg/L), with similar resistance patterns. Conclusions: Taken together, the present study is the first report of resistance to both mupirocin and FA among S. epidermidis isolates. Dissemination of S. epidermidis ST2 clone with both FA and mupirocin resistance can cause trouble in controlling S. epidermidis infections and eradication of staphylococci colonization.
... However, the currently available topical formulations of FA fail to penetrate across the wound eschar leading to sub-optimal therapeutic efficacy. Moreover, topical formulation of FA has to be applied 2-3 times daily for several days leading to poor patient compliance [12]. ...
The current research study intends to explore the combined potential of lipid nanoparticles and chitosan as an optimum therapy for the management of wound infections. Fusidic acid (FA), a steroidal antibiotic employed for treatment of primary and secondary topical infections was encapsulated within the nanoengineered lipid-polymer hybrid nanoparticles (FA-LPHNs). A number of variables like lipid/polymer ratio, lipid, surfactant and chitosan concentration, stirring speed were optimized to get the desired particle size and % entrapment efficiency. The developed carriers were further characterized for particle size, antibacterial activity, cytotoxicity studies in HaCat cell lines, ex vivo permeation studies and skin safety profile. The developed LPHNs offered nanometric size (284.67 ± 5.67 nm), sustained drug release (79.31 ± 0.45%) and enhanced drug permeation (72.09 ± 1.26%). The changes in viability of HaCat cells were insignificant indicating the safety profile of LPHNs. The administration of FA-LPHNs resulted in 5-times and 4-times decrease in its inhibitory concentration against MRSA 33591 and MSSA 25921 respectively, along with antibacterial activity for a longer duration. Further, hydrogel incorporated nanoparticles were found to be topically applicable and compatible with mice skin. The studies indicated the superiority of FA-LPHNs for better management of wounds and associated infections over the conventional marketed product.
... After one week of treatment, wounds from both groups showed a similar healing outcome, indicating that fusidic acid and mupirocin had a comparable efficacy. Topical fusidic acid (sodium fusidate) is a widely used antibiotic in dermatological practice since it covers most gram-positive bacteria including Staphylococcus aureus and Beta-hemolytic streptococci [31,32]. Mupirocin ointment is also widely used in skin infections for many years, especially for infection caused by Staphylococcus aureus [33]. ...
The review systematizes and analyzes the literature data about the pharmacodynamic effects alongside the established antibacterial properties of the antibiotic substance — fusidic acid from the fusidane class. According to several sources, the substance is characterized with its anti-inflammatory, immunosuppressive, anticancer, and antiviral activities. It has been proven that fusidic acid can inhibit lymphocyte activation and the production of pro-inflammatory cytokines in lymphocytes, mononuclear cells, and leukocyte chemotaxis. It inhibits the activation and proliferation of T-lymphocytes in response to phytohemagglutinin and the development of septic shock in response to S. aureus enterotoxin and LPS. The cytoprotective action of fusidic acid on pancreatic islet cells is demonstrated in a model of insulin and glial cells exposed to a cytotoxic substance. When applied externally, its anti-inflammatory effect is comparable to that of low- and moderately-active glucocorticosteroids. The efficacy of fusidic acid in reducing inflammation-induced edema of epidermal proliferation and decreasing the synthesis of critical pro-inflammatory cytokines is comparable to that of dexamethasone at equivalent concentrations. The immunomodulatory and anti-inflammatory properties of this antibiotic substance are clinically significant, enhancing its antibacterial effect, facilitating quicker relief of inflammation, resolution of inflammatory infiltrates, improvement of patient’s quality of life by expediting the removal of unpleasant sensations associated with inflammation and mitigating the repercussions of the inflammatory process.
Microemulsion gel, as a promising transdermal nanoparticle delivery system, addresses the limitations of microemulsions and enhances their performance in drug delivery and release. This article aims to discuss the advantages of microemulsion gel, including improved drug bioavailability, reduced drug irritation, enhanced drug penetration and skin adhesion, and increased antimicrobial properties. It explores the methods for selecting microemulsion formulations and the general processes of microemulsion preparation, as well as commonly used oil phases, surfactants, and co-surfactants. Additionally, the biomedical applications of microemulsion gel in treating conditions, such as acne and psoriasis, are also discussed. Overall, this article elucidates the significant potential of microemulsion gel in topical drug delivery, providing insights into future development and clinical applications.
The skin is the biggest organ in the human body. It is the first line of protection against invading pathogens and the starting point for the immune system. The focus of this review is on the use of amphibian-derived peptides and antimicrobial peptides (AMPs) in the treatment of wound healing. When skin is injured, a chain reaction begins that includes inflammation, the formation of new tissue, and remodelling of existing tissue to aid in the healing process. Collaborating with non-immune cells, resident and recruited immune cells in the skin remove foreign invaders and debris, then direct the repair and regeneration of injured host tissues. Restoration of normal structure and function requires the healing of damaged tissues. However, a major issue that slows wound healing is infection. AMPs are just one type of host-defense chemicals that have developed in multicellular animals to regulate the immune response and limit microbial proliferation in response to various types of biological or physical stress. Therefore, peptides isolated from amphibians represent novel therapeutic tools and approaches for regenerating damaged skin. Peptides that speed up the healing process could be used as therapeutic lead molecules in future research into novel drugs. AMPs and amphibian-derived peptides may be endogenous mediators of wound healing and treat non-life-threatening skin and epithelial lesions. Hence, this article describes different peptides used in wound healing, theirmethods of preparation, and their routes of administration.
In recent years, the unprecedented rise of bacterial antibiotic resistance together with the lack of adequate therapies have made the treatment of skin infections and chronic wounds challenging, urging the scientific community to focus on the development of new and more efficient treatment strategies. In this context, there is a growing interest in the use of natural molecules with antimicrobial features, capable of supporting wound healing i.e., antimicrobial peptides (AMPs), for the treatment of skin and soft tissue infections. In this review, we give a short overview of the bacterial skin infections as well as some of the classic treatments used for topical application. We then summarize the AMPs classes, stressing the importance of the appropriate selection of the peptides based on their characteristics and physicochemical properties in order to maximize the antibacterial efficacy of the therapeutic systems against multi-drug resistant pathogens. Additionally, the present paper provides a comprehensive and rigorous assessment of the latest clinical trials investigating the efficacy of AMPs in the treatment of skin and soft tissue infections, highlighting the relevant outcomes. Seeking to obtain novel and improved compounds with synergistic activity, while also decreasing some of the known side effects of AMPs, we present two employed strategies using AMPs: (i) AMPs-conjugated nanosystems for systemic and topical drug delivery systems and (ii) antibiotics-peptide conjugates as a strategy to overcome antibiotics resistance. Finally, an important property of some of the AMPs used in wound treatment is highlighted: their ability to help in wound healing by generally promoting cell proliferation and migration, and in some cases re-epithelialization and angiogenesis among others.
Thus, as the pursuit of improvement is an ongoing effort, this work presents the advances made in the treatment of skin and soft tissue infections along with their advantages and limitations, while the still remaining challenges are addressed by providing future prospects and strategies to overcome them.
Verordnungsprofil Seit Jahren verändert sich das Verordnungsspektrum der zahlreicher dermatologischer Wirkstoffklassen nur marginal. Wie in den Vorjahren werden topische Glukokortikoide am häufigsten verordnet. Auf sie entfallen 43 von 100 Dermatikatagesdosen. Antimykotika und Psoriasismedikamente (jeweils 11 %), Medikamente bei aktinischer Keratose und Aknemedikamente (jeweils 7 %), Antiinfektiva und Warzenmedikamente (jeweils 5 %), Wundbehandlungsmedikamente und Antipruriginosa (jeweils 4 %) sowie Rosazeamedikamente (3 %) werden deutlich seltener verordnet. Aufgrund der dem Arzneiverordnungs-Report zugrunde liegenden Systematik werden in den Tabellen zu den Dermatikaverordnungen wesentliche Veränderungen in der Therapie chronisch-entzündlicher Dermatosen nicht vollständig abgebildet. Dies betrifft die Verwendung monoklonaler Antikörper (Biologika) und JAK-Inhibitoren bei der Behandlung schwerer Fälle von atopischer Dermatitis oder Psoriasis (Lauffer und Biedermann 2022; Griffiths et al. 2021). Trend Die Verordnungen in den einzelnen Marktsegmenten werden weitgehend durch nationale und internationale Therapieempfehlungen gestützt. Die Gesamtverordnungsmenge bezogen auf DDD stieg 2021 im Vergleich zum Vorjahr um 3,9 %, mit deutlicheren Zuwächsen bei den Psoriasismedikamenten, den Aknemedikamenten und den Glukokortikoidtopika. Wesentliche Veränderungen in der Therapie der atopischen Dermatitis und der chronisch entzündlichen Hauterkrankungen werden vor allem bei Betrachtung der Kostenentwicklung deutlich: So entfällt 2021 weit über die Hälfte der gesamten dermatologischen Verordnungskosten von 2,7 Mrd. € auf die vier hier berücksichtigten monoklonalen Antikörper Dupilumab, Ustekinumab, Secukinumab, Guselkumab.
Auf einen Blick
Verordnungsprofil Seit Jahren verändert sich das Verordnungsspektrum der zahlreichen dermatologischen Wirkstoffklassen nur marginal. Wie in den Vorjahren werden topische Glukokortikoide am häufigsten verordnet. Auf sie entfallen 43 von 100 Dermatikatagesdosen. Antimykotika (11 %), Psoriasismittel (10 %), Mittel bei aktinischer Keratose (7 %), Aknemittel, Antiinfektiva und Warzenmittel (jeweils 6 %), Wundbehandlungsmittel (4 %) sowie Rosazeamittel und Antipruriginosa (jeweils 3 %) werden deutlich seltener verordnet.
Trend Die Verordnungen in den einzelnen Marktsegmenten werden weitgehend durch nationale und internationale Therapieempfehlungen gestützt. Die Gesamtverordnungsmenge bezogen auf DDD stieg 2020 im Vergleich zum Vorjahr lediglich um 2 %, mit deutlicheren Zuwächsen bei den Psoriasismitteln, den Aknemitteln und den Glukokortikoidtopika. Wesentliche Veränderungen in der Therapie chronisch entzündlicher Hauterkrankungen werden vor allem bei Betrachtung der Kostenentwicklung deutlich: So entfällt 2020 in etwa die Hälfte der gesamten dermatologischen Verordnungskosten von 2.254 € auf die drei hier berücksichtigten Biologika Ustekinumab, Secukinumab, Guselkumab.
Topical therapy is a mainstay of dermatological treatment and holds many advantages, including ease of use, relative lack of systemic side effects, and patient-directed application. In hidradenitis suppurativa (HS), topical therapeutics are often used for early-stage lesions or as adjunct therapy to systemic or surgical treatments. The four categories of disease-modifying topical therapies for sHS include antibiotics, antiseptics, keratolytics, and bathing additives (each of which will be discussed in this chapter), while topical therapies aimed at symptom-control such as analgesics and antipruritics are reviewed in Chapter 19. Unfortunately, there is a lack of robust evidence supporting the use of most topical therapies in HS. Thus, in the absence of rigorous data, the decision regarding which topical treatment to use is often made at the clinician’s discretion as well as the patient’s preference. This chapter will provide an overview of topical therapies, including their dosing schedules, mechanisms of action, contraindications, and recommendations for use to better inform these decisions.
Topical antibacterials are commonly used for superficial pyodermas such as impetigo and treatment or prevention of infections following minor cuts, abrasions, burns, and surgical wounds. Several antibiotics and antiseptics are available for use in different indications. One of the major uses of topical antibacterials is acne in which benzoyl peroxide is the drug of the first choice either singly or in combination with antibiotics or retinoids. Mupirocin and fusidic acid are the two most commonly used antibiotics for the treatment of superficial pyodermas and eradication of staphylococcal carrier state. Bacterial resistance to topical antibiotics is a growing concern and topical antiseptics such as gentian violet are getting renewed interest as alternatives. Incidence of contact dermatitis is a limiting factor for the use of several topical antibacterials. Although many botanical products have demonstrated in vitro activities against skin pathogens, their clinical utilities remain to be established by good-quality clinical trials.
Background
While patients and families struggling with atopic dermatitis (AD) have documented concerns for a contributory role of skin care products in AD pathology, nearly all the skin microbiome studies to date have asked participants to avoid topical products (such as soaps or select medications) for the preceding days to weeks prior to sample collection. Thus, given the established role of the microbiome in AD, the interactions between topical exposures, dysbiosis and AD remains underrepresented in the academic literature.
Objectives
To address this knowledge gap, we expanded our previous evaluations to test the toxicological effects of a broader range of common chemicals, AD treatment lotions, creams and ointments using both health‐ and AD‐associated strains of Roseomonas mucosa and Staphylococcus spp.
Methods
Use of in vitro culture techniques and mouse models were deployed to identify chemicals with dysbiotic or pre‐biotic potential. A proof‐of‐concept study was subsequently performed in healthy volunteers to assess global microbiome shifts after exposure to select chemicals using dermatologic patch testing.
Results
Numerous chemicals possessed antibiotic properties, including many not marketed as anti‐microbials. Through targeted combination of potentially beneficial chemicals, we identified combinations which promoted the growth of health‐associated isolates over disease‐associated strains in bacterial culture and enhanced microbe‐specific outcomes in an established mouse model of AD; the most promising of which was the combination of citral and colophonium (often sold as lemon myrtle oil and pine tar). Additional studies would likely further optimize the combination of ingredients use. Similar results were seen in the proof‐of‐concept human studies.
Conclusions
Our results could offer a systematic, multiplex approach to identify which products carry dysbiotic potential and thus may guide formulation of new topicals to benefit patients with AD.
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Verordnungsprofil Seit Jahren verändert sich das Verordnungsspektrum der zahlreichen dermatologischen Wirkstoffklassen nur marginal. Wie in den Vorjahren werden topische Corticosteroide am häufigsten verordnet. Auf sie entfällt fast jede zweite verordnete Dermatikatagesdosis. Antimykotika (12 %), Psoriasismittel (10 %), Aknemittel (6 %), Antiinfektiva (5 %), Warzenmittel, Wundbehandlungsmittel und Mittel bei aktinischen Keratosen (jeweils 4 %) sowie Rosazeamittel und Antipruriginosa (jeweils 3 %) werden deutlich seltener verordnet. Die verbleibenden Gruppen hatten 2019 zusammen nur noch einen Verordnungsanteil von weniger als 3 %.
Trend Die Verordnungen in den einzelnen Marktsegmenten werden weitgehend durch nationale und internationale Therapieempfehlungen gestützt. Die Gesamtverordnungsmenge bezogen auf DDD stieg 2019 im Vergleich zum Vorjahr lediglich um 2,3 %, mit deutlicheren Zuwächsen bei den Corticosteroidtopika und den Psoriasismitteln. Die Mehrverordnungen sind jedoch mit Kostensteigerungen von 13,5 % verbunden, die in erster Linie auf das Konto der hochwirksamen Biologika (Ustekinumab, Secukinumab, Guselkumab) zur Behandlung der Psoriasis gehen. Damit entfällt fast die Hälfte der gesamten dermatologischen Verordnungskosten (1.934 Mio. €) nur auf diese drei Präparate.
Pyodermas are the most frequent reason for visiting dermatologists among children. The immunity to development of pyodermas is based on skin barrier the part of which is cutaneous microbiome. The microbiome composition is unique and depends on age, localization on various body regions, environment. The change of its qualitative and quantitative composition leads to the development of purulent dermal diseases characterized by clinical diversity and severe course and development of complications (without adequate treatment). In this regard the choice of the correct therapy remains relevant. The results of studies covering the effectiveness of various topic antibacterial agents are analysed. Practical aspects of pyodermia therapy in children using local therapy are illustrated.
Introduction: Hidradenitis suppurativa (HS) is a chronic, inflammatory and debilitating skin disease. Several pharmacologic agents have been described to reduce lesion activity and inflammation in HS. In this study, we have reviewed the available antibiotic therapies for HS, analyzing the pharmacologic aspects of these kind of treatments.
Areas covered: The role of bacteria, infections and superinfections in HS is still debated and controversial. Antibiotics are recognized as first-line treatments for hidradenitis suppurativa, but the data on their efficacy are limited. Antibiotics should not be replaced by new biological therapies and it is not necessary to make an efficacy classification: it is important for dermatologists to recognize the right patient and the right moment to prescribe an antibiotic therapy, together or in a rotational way with other therapeutic options.
Expert Opinion: The HS treatment process for the physicians is often complicated by the disease’s severity and several comorbidities. Fortunately, the better understanding of HS pathogenesis has been used to improve treatment strategies. Antibiotic therapy is an effective treatment of patients with HS but probably, in the next five years, many therapeutic options will be available, which will change the way we manage the disease, especially the moderate-to-severe forms of HS.
The use of targeted therapies, when added to conventional chemotherapy, has significantly improved clinical outcomes and survival of cancer patients. While targeted therapies do not have the systemic adverse reactions of chemotherapy, they are associated with toxicities that can be severe and impair patient quality of life and adherence to anti-cancer treatment. Panitumumab and cetuximab, two monoclonal antibodies against epidermal growth factor receptor (EGFR), are recommended for the treatment of metastatic colorectal cancer (mCRC). The majority of patients with mCRC who are treated with anti-EGFR therapy develop skin toxicities, including papulopustular rash (the most common), xerosis, painful cracks and fissures on the palms and soles of the feet, paronychia, pruritus, and abnormal hair and eyelash growth; they are also more prone to skin infections. Given the involvement of EGFR in normal epidermis physiology, development and function, skin toxicities caused by anti-EGFR therapy are not unexpected. In recent years, recommendations have been formulated for the prevention and treatment of anti-EGFR therapy-related skin toxicities. Indeed, proper and timely management of these toxicities is important for ensuring uninterrupted anti-cancer treatment and optimal outcomes. Here, we review the current knowledge of anti-EGFR therapy-related skin toxicities and the latest recommendations for their management. We also present a treatment approach for papulopustular rash based on the combination of fusidic acid plus betamethasone in a lipid-enriched topical formulation. The effectiveness of this approach is documented by the presentation of five cases successfully treated in clinical practice for anti-EGFR therapy-related rash.
Dear Editor, Folliculitis decalvans (FD) is a rare form of primary neutrophilic cicatricial alopecia. It is a highly distressing disease that affects young and middle-aged adults, with a slight male predominance (1). The most frequent clinical manifestations are follicular pustules and diffuse and perifollicular erythema that heal with centrifugal scarring. Follicular tufting, erosions, and hemorrhagic crusts can also be present, and this alopecia is most often located at the vertex and occipital area. Patients frequently complain about pain, itching, or burning sensations, and the involvement of other body areas is rare (2). The pathogenesis of this disease remains unclear. Staphylococcus aureus and other hair follicle bacteria can often be isolated from the pustules, suggesting the role of a bacterial infection in its etiology. A defect in the host's immune response can also be postulated by reports of familial cases and the appearance of FD in patients with immunity dysfunctions. Other mechanical factors have been suggested, such as structural abnormalities of the follicle or local inflammation (2). Management of this alopecia is difficult and its course is typically chronic and relapsing. The treatment aim is to stop inflammation and further irreversible destruction of hair follicles. Antibiotics remain the first-line therapy, due both to their anti-inflammatory and antimicrobial properties (1). Although topical fusidic acid is widely used as adjuvant treatment, there are few data regarding its oral use. We report a case of folliculitis decalvans successfully treated with oral fusidic acid. Our patient was a 41-year old Cape Verdean woman with a two month history of alopecia with painful, purulent discharge at the vertex of the scalp. The patient was diagnosed with human immunodeficiency virus type 1 (HIV-1) infection 5 years prior and was stable on her regimen of efavirenz, tenofovir, and emtricitabine, with undetectable viral load. She denied application of topical or capillary products. Dermatological examination revealed a patch of cicatricial alopecia with crusts and follicular pustules (Figure 1). Direct microscopic examination and mycological culture showed no fungal element. A diagnosis of folliculitis decalvans was established and the patient was started on oral fusidic acid at a dose of 500 mg three times a day. Betamethasone dipropionate 0.05% and salicylic acid 3% lotion as well as azelaic acid 5% lotion were also applied to the affected area once daily. After two months of treatment, the patient showed clinical improvement, with less erythema and suppuration of the affected scalp. A partial hair regrowth was noted, mainly at the periphery. Subsequently the patient maintained only topical therapy, and no recurrences were observed after 6-months of follow-up. Fusidic acid is useful in the treatment of skin and soft tissue infections, particularly those due to S. aureus, as shown by randomized controlled studies (3). The clinical efficacy of fusidic acid in the treatment of folliculitis decalvans has been reported previously. Bogg was the first to describe this useful effect (4). Sutter also reported good results with fusidic acid used both topically and orally (500 mg three times a day) (5). However, both failed to report the treatment duration or the outcome on discontinuation. Abeck described three patients that responded to a three week oral course of fusidic acid (500 mg three times a day) and to a maintenance treatment with zinc sulfate (4). During the following year, recurrence was observed in only one patient after ending zinc sulfate therapy. Oral antibiotics are frequently used to treat folliculitis decalvans. Tetracyclines and the combination of clindamycin with rifampicin are the most commonly used (2). However, the disease usually progresses when treatment is stopped. Fusidic acid is an anti-staphylococcal drug with few adverse effects. It is highly bioavailable orally, and has a long plasma half-life. Despite years of clinical use in numerous countries, resistance rates remain at low levels to date (6). Since clinical series or cases including ours have shown good results, this drug should not be forgotten when considering treatment options for folliculitis decalvans.
Objectives: The aim of this study was to describe the relationship among abstract structure, readability, and completeness, and how these features may influence social media activity and bibliometric results, considering systematic reviews (SRs) about interventions in psoriasis classified by methodological quality.
Study Design and Setting: Systematic literature searches about psoriasis interventions were under- taken on relevant databases. For each review, methodological quality was evaluated using the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) tool. Abstract extension, structure, readability, and quality and completeness of reporting were analyzed. Social media activity, which consider Twitter and Facebook mention counts, as well as Mendeley readers and Google scholar citations were obtained for each article. Analyses were conducted to describe any potential influence of abstract characteristics on review’s social media di↵usion.
Results: We classified 139 intervention SRs as displaying high/moderate/low methodological quality. We observed that abstract readability of SRs has been maintained high for last 20 years, although there are some di↵erences based on their methodological quality. Free-format abstracts were most sensitive to the increase of text readability as compared with more structured abstracts (IMRAD or 8-headings), yielding opposite e↵ects on their quality and completeness depending on the methodological quality: a worsening in low quality reviews and an improvement in those of high-quality. Both readability indices and PRISMA for Abstract total scores showed an inverse relationship with social media activity and bibliometric results in high methodological quality reviews but not in those of lower quality.
Conclusion: Our results suggest that increasing abstract readability must be specially considered when writing free-format summaries of high-quality reviews, because this fact correlates with an improvement of their completeness and quality, and this may help to achieve broader social media visibility and article usage.
Condyloma acuminatum (CA), or genital wart, is a sexually transmitted infection caused by human papillomaviruses. Increasing evidences demonstrated that photodynamic therapy (PDT) is effective in eliminating latent HPV infection, the major reason for CA recurrence. We observed an increasing number of infections after PDT in CA patients, which has not been reported before. This study aims to evaluate the incidence and management of infection in CA patients after PDT procedure. CA patients received PDT from January 2015 to February 2016 at the outpatient setting. Patients were randomly divided into two groups: the control group and fusidic acid group. Patients in the fusidic acid group used topical fusidic acid (2%) and recombinant human interferon after 5-aminolevulinic acid (ALA)-PDT procedure, while patients in the control group only used recombinant human interferon. Patients came to our department for follow-up evaluations at 4, 8, and 12 weeks after treatment for three times of PDT. Patients with ALA-PDT-associated infection were then randomly divided into two groups: the fusidic acid group and mupirocin group. During the 13-month study period, a total of 718 patients with 2154 times of PDT procedures were enrolled. The infection rate after PDT was 8.5% in the control group, while it was 1.1% in the prophylactic topical fusidic acid group. The cure rate of PDT-associated infection was 85.7% in the fusidic acid group and 86.7% in the mupirocin group. In conclusion, prophylactic topical antibiotic was useful for reduction of PDT-associated infection and optimal wound healing in CA patients.
Dermatika zählen in Deutschland zu den verordnungsstärksten Arzneimitteln. Ihre Anwendungsgebiete sind sehr unterschiedlich. Entsprechend heterogen sind die Stoffklassen, die von den Corticosteroidexterna über die dermatologischen Anti mykotika sowie die Wundbehandlungsmittel bis zu den Hautschutz- und Pflegemitteln reichen (Abbildung 25.1).
Objectives: No gold standard exists to assess methodological quality of systematic reviews (SRs). Although AMSTAR is widely accepted for analysing quality, the ROBIS instrument has recently been developed. This study aimed to compare the capacity of both instruments to capture the quality of SRs concerning psoriasis interventions.
Study Design and Setting: Systematic literature searches were undertaken on relevant databases. For each review, methodological quality and bias risk were evaluated using the AMSTAR and ROBIS tools. Descriptive and principal component analyses were conducted to describe similarities and discrepancies between both assessment tools.
Results: We classified 139 intervention SRs as displaying high/moderate/low methodological quality, and as high/low risk of bias. A high risk of bias was detected for most SRs classified as displaying high or moderate methodological quality by AMSTAR. When comparing ROBIS result profiles, responses to domain 4 signalling questions showed the greatest differences between bias risk assessments, while domain 2 items showed the least.
Conclusion: When considering SRs published about psoriasis, methodological quality remains suboptimal, and the risk of bias is elevated, even for SRs exhibiting high methodological quality. Further, the AMSTAR and ROBIS tools may be considered as complementary when conducting quality assessment of SRs.
Terpenoids are a very prominent class of natural compounds produced in diverse genera of plants, fungi, algae and sponges. They gained significant pharmaceutical value since prehistoric times, due to their broad spectrum of medical applications. The fragrant leaves of Eucalyptus trees are a rich source of terpenoids. Therefore this review starts by summarizing the main terpenoid compounds present in Eucalyptus globulus, E. citriodora, E. radiata and E. resinifera and describing their biosynthetic pathways. Of the enormous number of pharmaceutically important terpenoids, this paper also reviews some well established and recently discovered examples and discusses their medical applications. In this context, the synthetic processes for (-)-menthol, (-)-cis-carveol, (+)-artemisinine, (+)-merrilactone A and (-)-sclareol are presented. The tricyclic sesquiterpene (-)-englerin A isolated from the stem bark of the Phyllanthus engleri plant (Euphorbiaceae) is highly active against certain renal cancer cell lines. In addition, recent studies showed that englerin A is also a potent and selective activator of TRPC4 and TRPC5 calcium channels. These important findings were the motivation for several renowned research labs to achieve a total synthesis of (-)-englerin A. Two prominent examples-Christmann and Metz-are compared and discussed in detail.
Resistance to fusidic acid in Staphylococcus aureus is caused by mutation of the elongation factor G (EF-G) drug target (FusA class) or by expression of a protein that protects
the drug target (FusB and FusC classes). Recently, two novel genetic classes of small-colony variants (SCVs) were identified
among fusidic acid-resistant mutants selected in vitro (FusA-SCV and FusE classes). We analyzed a phylogenetically diverse
collection of fusidic acid-resistant bacteremia isolates to determine which resistance classes were prevalent and whether
these were associated with particular phylogenetic lineages. Each isolate was shown by DNA sequencing and plasmid curing to
carry only one determinant of fusidic acid resistance, with approximately equal frequencies of the FusA, FusB, and FusC genetic
classes. The FusA class (mutations in fusA) were distributed among different phylogenetic types. Two distinct variants of the FusC class (chromosomal fusC gene) were identified, and FusC was also distributed among different phylogenetic types. In contrast, the FusB class (carrying
fusB on a plasmid) was found in closely related types. No FusE-class mutants (carrying mutations in rplF) were found. However, one FusA-class isolate had multiple mutations in the fusA gene, including one altering a codon associated with the FusA-SCV class. SCVs are frequently unstable and may undergo compensatory
evolution to a normal growth phenotype after their initial occurrence. Accordingly, this normal-growth isolate might have
evolved from a fusidic acid-resistant SCV. We conclude that at least three different resistance classes are prevalent among
fusidic acid-resistant bacteremia isolates of S. aureus.
Trimethoprim-polymyxin B sulphate cream or fusidic acid cream was used to treat 64 patients with primary or secondary superficial bacterial infections of the skin in a randomized, double-blind controlled trial. Both treatments were effective in alleviating the clinical signs and symptoms associated with bacterial infection. A cream containing a combination of 0.17 mg/g trimethoprim and 10,000 IU/g polymyxin B sulphate was, however, significantly more effective than a 20 mg/g fusidic acid cream in reducing the signs of crust and tenderness.
A study has been conducted on 101 patients with superficial skin sepsis comparing the effectiveness of topical treatment with 2% sodium fusidate ointment and a new preparation containing 2% fusidic acid in a cream base.
The results showed that both topical preparations were equally effective in terms of the number of days for healing to take place and in the subjective assessment of the clinical response. Bacteriological investigation of the swabs from ninety-one patients showed Staphylococcus aureus to be the most frequently isolated pathogen. Both preparations were well tolerated and no adverse reactions were observed.
It is suggested that the new 2% fusidic acid cream is particularly suitable for use on lesions requiring no dry dressing, whereas the 2% sodium fusidate ointment is preferred for those conditions where a dressing is applied.
Fusidic acid cream and mupirocin ointment were compared in 177 general practice patients with facial impetigo. Both preparations were applied three times daily, and the response was assessed after six to eight days. The preparations were equally effective clinically. Ninety of the 93 (96.8%) patients given fusidic acid cream and 82 of the 84 (97.6%) patients given mupirocin ointment responded to treatment. Both treatments were equally effective when pathogenic bacteria were isolated pretreatment. Adverse effects were minor and were recorded in 4.1% of the mupirocin-treated patients and in 1.9% of the patients using fusidic acid. The patient acceptability of fusidic acid cream was significantly superior to that of mupirocin ointment.
The efficacy, tolerability and acceptability of betamethasone valerate 0.1%/fusidic acid 2% cream and betamethasone valerate 0.1%/clioquinol 3% cream were compared in 120 patients of either sex, aged 18 years or over, with a clinical diagnosis of infected hand eczema. Both creams were applied twice daily for up to 4 weeks. Assessments were made by the investigator and by the patient at baseline and at 1, 2 and 4 weeks. Swabs were taken for bacteriological culture at baseline and at the end of treatment. Overall, both creams were similarly effective clinically, with 57.9% of patients given betamethasone/clioquinol and 60.4% of patients given betamethasone/fusidic acid responding (NS; 95% confidence interval for difference -16.1, 21.2). However, betamethasone/fusidic acid cream gave a significantly better bacteriological response (P < 0.005). Both treatments were well tolerated. Betamethasone/fusidic acid cream was considered by the patients to be a significantly more cosmetically acceptable treatment (P < 0.0001).
Fusidic acid cream and mupirocin ointment were compared in 206 general practice patients with acute skin sepsis. Both preparations were applied twice daily, and the response was assessed after six to eight days. The preparations were equally effective clinically. Ninety-nine of the 104 (95.2%) patients given fusidic acid and one hundred of the 102 (98.0%) patients given mupirocin ointment responded to treatment. Adverse effects were minor but were recorded in 4.2% of mupirocin-treated patients and in 1.8% of patients using fusidic acid. The patient acceptability of fusidic acid cream was superior to that of mupirocin ointment.
One hundred and ninety-two patients with skin and/or soft tissue infection, for which oral antibacterial therapy was indicated, received 5-10 days' treatment with fusidic acid 250 mg twice daily or ciprofloxacin 250 mg twice daily. The proportions of patients who were 'cured' or 'improved' after treatment were 86.6% for fusidic acid and 91.5% for ciprofloxacin (p = 0.28; OR = 0.60; CI: 0.24, 1.52). Bacteriological efficacy of the two treatments was 86.5% for fusidic acid and 90.0% for ciprofloxacin. Adverse events were recorded in 16 (16.5%) patients given fusidic acid and in 21 (22.3%) patients given ciprofloxacin. Adverse events contributed to treatment withdrawal in only one (0.9%) patient, who was given fusidic acid. Fusidic acid 250 mg twice daily and ciprofloxacin 250 mg twice daily for 5-10 days were similarly highly effective in treating patients with skin and soft tissue infections. Fusidic acid should be used in preference to ciprofloxacin in community acquired skin and soft tissue infections.
Two low dosage regimens of fusidic acid tablets (250 mg twice daily and 500 mg twice daily) and the standard fusidic acid regimen (500 mg three times daily) were compared in a randomised, double blind study in 617 patients with skin and soft-tissue infections. Treatment was given for five to 10 days. The cure rates after five days' treatment were 34.7% for fusidic acid 250 mg twice daily, 37.8% for fusidic acid 500 mg twice daily and 37.2% for fusidic acid 500 three times daily. The end of treatment cure rates were 75.5% for fusidic acid 250 mg twice daily, 81.1% for fusidic acid 500 mg twice daily and 74.0% for fusidic acid 500 mg three times daily. The response ('cured' or 'improved') was similar at 91.3%-95.5% of patients in the three treatment groups. All three treatments proved equally effective in patients with furuncules, superficial abscesses, acute paronychia, wound infections or impetigo. Clinical efficacy in 'sensitive' infections (Staphylococcus aureus and/or β-haemolytic streptococci susceptible in vitro to fusidic acid) was 97.8% (87/89) for fusidic acid 250 mg twice daily, 98.8% (82/83) for fusidic acid 500 mg twice daily and 98.5% (66/67) for fusidic acid 500 mg three times daily. Adverse events were recorded in 36 (17.8%) patients given fusidic acid 250 mg twice daily, in 40 (19.7%) patients given fusidic acid 500 mg twice daily and in 50 (24.9%) patients given fusidic acid 500 mg three times daily. Sixteen patients ceased treatment due to adverse events: four (1.9%) patients had taken fusidic acid 250 mg twice daily, three (1.5%) patients had taken fusidic acid 500 mg twice daily and nine (4.4%) patients had taken fusidic acid 500 mg three times daily.
Two different dosage regimens of fusidic acid tablets (250 mg twice daily and 500 mg twice daily) and a standard regimen of flucloxacillin (500 mg three times daily) were compared in a randomised, double blind study in 540 patients with skin and soft-tissue infections. Treatment was given for five to 10 days. The cure rates after five days' treatment were 32.2% for fusidic acid 250 mg, 27.9% for fusidic acid 500 mg and 21.1% for flucloxacillin (fusidic acid 250 mg vs. flucloxacillin; p < 0.05). The end of treatment cure rates were 68.9% for fusidic acid 250 mg, 68.2% for fusidic acid 500 mg and 65.9% for flucloxacillin. The overall response ('cured' or 'improved') at the end of treatment was similar at 92.6%-94.5% in the three treatment groups. At the end of treatment assessment, all three treatments proved equally effective in patients with abscesses, paronychia or wound infections. Clinical efficacy in 'sensitive' infections (Staphylococcus aureus and or β-haemolytic streptococci susceptible in vitro to treatment allocated) was 93.9% (31/33) for fusidic acid 250 mg, 92.6% (25/27) for fusidic acid 500 mg and 97.3% (36/37) for flucloxacillin. Minor adverse events were recorded in 22 (12.4%) patients given fusidic acid 250 mg, in 54 (30.2%) patients given fusidic acid 500 mg and in 40 (22.7%) patients given flucloxacillin. The incidence of adverse effects was significantly less in the fusidic acid 250 mg group compared with flucloxacillin (p = 0.02) or fusidic acid 500 mg (p = 0.0001). Diarrhoea/loose stools was the most common adverse event, and was significantly less common in the fusidic acid 250 mg group (5.1%) than in either the fusidic acid 500 mg group (12.3%; p = 0.02) or the flucloxacillin group (14.8%; p = 0.01). Upper gastrointestinal upset (7.3%) was significantly more common in the fusidic acid 500 mg group than in either the fusidic acid 250 mg (1.1%) or flucloxacillin groups (1.1%; p < 0.01). Seventeen patients ceased treatment due to adverse events: three (1.7%) patients had taken fusidic acid 250 mg, nine (5.0%) patients had taken fusidic acid 500 mg and five (2.8%) patients had taken flucloxacillin.
The efficacy of a 0.1% of betamethasone/2% fusidic acid cream was compared with that of a 0.1% betamethasone/0.5% neomycin preparation in a double-blind study involving 100 patients with infected or potentially infected eczema. Both preparations proved equally effective in reducing the severity of the lesions after one and two weeks of treatment. There were no differences between the two formulations in eradicating Staphylococcus aureus and beta-haemolytic streptococci from the lesions.
A previous study performed in healthy volunteers had demonstrated a good diffusion of fusidic acid (FA) in skin blister fluid, what allowed to obtain concentrations higher than MIC of streptococcus and staphylococcus with a half-reduced posology (500 mg/day). So, a multicenter randomised study including 273 patients with primary or secondary skin infections was performed in order to compare efficacy and safety in three parallel groups: group I treated with this reduced posology (90 patients), group II treated with FA at the usual dosage of 1 g/day (90 patients) and group III treated with pristinamycin (P) at the usual dosage of 2 g/day (93 patients). Global efficacy results did not show any statistically significant difference between the three groups in terms of percentage of cure or improvement (cure and improvement: 92% in the group I, 99% in the group II, 96% in the group III). However, skin infections with streptococcus isolated at the beginning or during the treatment were significantly related with an increase in failure risk in the group treated with FA reduced dosages, in comparison with the two other groups. At the end of the treatment, when a germ was isolated. Staphylococcus aureus was significantly more frequent in the group treated with P, but this was not linked to a higher failure risk. Safety was significantly better in both groups treated with FA (adverse events: 9.1% in group I, 12.6% in group II, 28.6% in group III). Adverse events were mainly digestive, and implied a treatment withdrawal in 2.3% of the patients in group I, 4.6 % in group II and 9.9 in group III.
BACKGROUND: The bacteriological implications of treating eczema infected with Staphylococcus aureus with topical betamethasone/fusidic acid have been reviewed. METHODS: A retrospective review and analysis of results from 8 previously conducted clinical studies was performed. RESULTS: Overall, bacteriological efficacy was recorded in 326 (89.6%) of the 364 patients assessed. In comparative studies, bacteriological efficacy was 86.0% for betamethasone/ neomycin (n.s.), 85.4% for betamethasone/gentamicin (n.s.), 69.6% for betamethasone/clioquinol ( P = 0.04), 70.4% for betamethasone ( P < 0.01) and 25.0% for an ointment vehicle ( p < 0.001). The emergence of fusidic acid-resistant strains of S. aureus was seen in nine (2.8%) patients given betamethasone/ fusidic acid and in six (2.5%) patients given comparator treatment. CONCLUSION: When betamethasone/fusidic acid treatment is given for short periods there is little selection pressure on the development of resistance to fusidic acid. ( J Dermatol Treat (2000) 11: 143-149)
Aim To compare the clinical efficacy of a cream combination containing 2% fusidic acid and 1% hydrocortisone acetate in the treatment of patients with mild to moderate atopic dermatitis.Subject Atopic dermatitis and efficacy of antibacterial and antiinflammatory topical therapy.Methods Randomized, double blind, prospective, parallel group trials.Results Study I, involving 186 patients, compared the combination 2% fusidic acid and 1% hydrocortisone acetate with 1% hydrocortisone cream. Analysis was performed on patients who had pathogens at entry and on the total patient population. Study II, involving 68 patients, compared the combination 2% fusidic acid and 1% hydrocortisone acetate with 2% fusidic acid cream. Analysis was the same as in study I.Results of study I in patients with pathogens at baseline showed a significant difference in favour of the combination (P = 0.04) in terms of the primary efficacy criterion which was a combination of clinical and bacteriological efficacy measures. When all patients in the study were analyzed there was no significant difference between the two groups. The combination was significantly more effective in removing pathogens than 1% hydrocortisone cream (P < 0.0001).Results of study II in all patients showed that the combination was significantly better than 2% fusidic acid cream (P = 0.04) in terms of the primary efficacy criterion. Both preparations were highly successful in eradicating pathogens.Pooled analysis of studies I and II showed a difference with respect to the primary efficacy criterion among the 3 preparations in the order Fucidin 2% plus HC 1% cream > HC 1% cream > Fucidin 2% cream in all patients and in those with pathogens (P = 0.007 for all patients and P = 0.01 for those with pathogens). Similarly, regarding the reduction in sign/symptom score a significant difference among the 3 preparations existed (P = 0.009 for all patients and P = 0.01 for those with pathogens). Adverse events with the combination were minimal.Conclusion 2% fusidic acid and 1% hydrocortisone acetate cream is an effective therapy in patients with mild to moderate degrees of atopic dermatitis.
Infection with Staphylococcus aureus is common in all forms of eczema. Production of superantigens by S. aureus increases skin inflammation in eczema; antibacterial treatment is thus pivotal. Poor patient compliance is a major cause of treatment failure; combination preparations that contain an antibacterial and a topical steroid and that work quickly can improve compliance and thus treatment outcome. Fusidic acid has advantages over other available topical antibacterial agents - neomycin, gentamicin, clioquinol, chlortetracycline, and the antifungal agent miconazole. The clinical efficacy, antibacterial activity and cosmetic acceptability of fusidic acid/corticosteroid combinations are similar to or better than those of comparator combinations. Fusidic acid/steroid combinations work quickly with observable improvement within the first week. Studies have shown that short-term (2 weeks) use of fusidic acid/corticosteroid combinations does not increase the development of resistance. A new formulation of fusidic acid with betamethasone valerate in a lipid cream also addresses xerosis in eczema.
Identify the bacteria responsible for cutaneous infections observed in private practice and test their sensitivity to currently used antibiotics.
The patients were examined by dermatologists. A bacteriological sample was taken and sent to a central laboratory for identification of the germ and antibiograms were performed and the minimal inhibiting concentrations (MIC) determined.
Folliculitis, impetigo and furuncles were the three most frequent primary infections. Four hundred and forty-three patients were included and 442 samples were placed in culture. Cultures were positive in 265 cases (a single bacterial strain in 231 cases). Staphylococcus aureus was isolated in 208 cases, streptococci in 11 and enterobacteria in 3; occasionally several germs were present. Eight strains of staphylococci were meti-R (4 p. 100). All the strains were sensitive to pristinamycin and mupirocin and 90 p. 100 were sensitive to fusidic acid.
The occurrence and diffusion of resistant strains is a daily concern in hospitals. In general practice, although care must be taken, the problem rarely occurs and the antibiotics used remain effective.
— Sodium fusidate ointment has been used in the treatment of erythrasma in a mental hospital. In comparison with a benzoic acid (Whitfield's) ointment it proved as effective in clearing fluorescent lesions (90%‚cure’) and more effective in clearing the associated Corynebacterium minutissimum. It was, however, less effective in removing scaling.
Aim. To study the efficacy, tolerability and acceptability of 2% fusidic acid and 1% hydrocortisone with 2% miconazole and 1% hydrocortisone Subject Atopic dermatitis and topical therapy flammatory remedies. Methods. A randomised, open, parallel group comparison. Results. 207 patients with clinically infected eczema were included in a trial with either 2% fusidic acid and 1% hydrocortisone or 2% miconazole and 1% hydrocortisone. At the end of treatment, there was no statistically significant difference between treatments in the preparations of patients 'cleared' or 'markedly improved' (fusidic acid 69.5%, miconazole 68.6%). After 1 week treatment, there was a statistically significant difference in the overall treatment response in favour of fusidic acid/hydrocortisone cream (P = 0.04). Fusidic acid/hydrocortisone cream was significantly more effective than miconazole/hydrocortisone cream at 1 week in reducing the total sign score (P = 0.001), erythema (P = 0.002), induration (P = 0.001), dryness/scaling (P = 0.02), and cracking/fissuring( P = 0.01). Fusidic acid/hydrocortisone cream was significantly more effective bacteriologically than miconazole/hydrocortisone cream (P = 0.04). Patients considered that treatment-related irritation was significantly more common with fusidic acid/hydrocortisone cream (P = 0.03). Adverse events were recorded in 7 (7.3%) patients given fusidic acid/hydrocortisone and in 8 (7.5%) patients given miconazole/hydrocortisone cream and contributed to treatment withdrawal in 1 (1.0%) patient given fusidic acid/hydrocortisone cream and in 3 (2.8%) patients given miconazole/hydrocortisone cream. Conclusion. Fusidic acid/hydrocortisone cream and miconazole/hydrocortisone cream were equally effective in treating clinically infected eczema. However, fusidic acid/hydrocortisone cream produced a significantly more rapid clinical improvement and was more effective bacteriologically. Both treatments were well tolerated.
Understand the development of bacterial resistance and multi-resistance following treatment with topical and systemic antibiotics is important for dermatologists. Furthermore the sensitization potential and toxicity of antibiotics applied to large skin areas must be considered. The advantage of many topical antibiotics is evident; extremely high concentrations can be achieved in the infected skin usually without any systemic side effects. When an antibiotic is used both systemically and topically, indications should be weighed carefully for topical use, in order to reduce the likelihood of sensitization to an potential systemic agent. Continuous monitoring of the resistance profile of important bacteria is also desirable, in order to preserve the utility of important “reserve antibiotics”. In this review the most important topical antibiotics used in Germany are evaluated with regards to efficacy and safety profile.
Mupirocin was introduced into clinical practice in the UK in 1985, and has proved to be an extremely effective treatment of skin infections and one of the most successful topical antibiotics for the clearance of nasal Staphylococcus aureus isolates including those resistant to methicillin. It is currently registered for use in more than 90 countries worldwide. Unfortunately resistance was described shortly after its initial use. Many of the issues regarding its use are reviewed here, together with the mechanisms, genetics, surveillance and epidemiology of resistance, particularly in staphylococci. The various factors that increase resistance and how they might be controlled are also discussed.
A study was carried out in 90 patients with superficial, soft-tissue infections to compare the effectiveness of topical treatment with 2% sodium fusidate ointment used alone, and oral antibiotic therapy (clindamycin, erythromycin, or flucloxacillin) plus a placebo ointment. The results showed that the number of days for healing to take place was significantly shorter with sodium fusidate ointment, and there was also a highly significant preference for it over oral antibiotic therapy in the subjective assessment of clinical response. Bacteriological investigations of swabs from 58 of the patients showed Staphylococcus aureus to be the most frequently isolated pathogen: 72% of the strains were penicillin-resistant but all were sensitive to sodium fusidate. It is suggested that oral antibiotic therapy should be reserved for those cases where there is evidence of systemic spread of the infection and that sodium fusidate ointment, with or without surgical drainage, should be the standard initial treatment in the out-patient and general practice situation.
This double-blind study of an antibiotic coritcosteroid combination, the antibiotic alone and the corticosteroid alone, compared their clinical and microbiological effect in infected atopic dermatitis. Combination therapy reduced the mean scores for infection, inflammation and overall severity to a greater extent than the antibiotic or corticosteroid alone. The clinical and microbiological date are discussed in terms of relevance to clinical use.
The biochemical mechanisms of resistance to fusidic acid in Staphylococcus aureus were investigated. Organisms possessing plasmid genes for resistance showed a high basal level of resistance, but could be induced to higher levels after pre-incubation with fusidic acid. This induction occurred rapidly and probably did not depend on gene dosage effects. Mutants resistant to fusidic acid, obtained from plasmid-negative cultures, expressed resistance constitutively. Protein synthesis in cell-free extracts from staphylococci with plasmid-mediated resistance to fusidic acid was as sensitive to fusidic acid as was synthesis in preparations from sensitive organisms; whereas protein synthesis in preparations from a spontaneous fusidic acid resistant mutant was resistant to the antibiotic. None of the resistant strains caused detectable inactivation of fusidic acid and no new derivative of fusidic acid was found in culture extracts of plasmid-possessing organisms grown in the presence of radioactive antibiotic. Expression of plasmid-mediated resistance to fusidic acid was associated with a decrease in the molar ratio of phosphatidylglycerol to lysylphosphatidylglycerol, but the cardiolipin content remained constant.
The fusidic acid steady-state concentrations in serum (S) and skin suction blister fluid (SBF) after oral doses of 250 and 500 mg administered twice daily for 6 days, as film-coated tablets of sodium fusidate, were studied in eight healthy subjects. The mean peak serum concentrations after the 250- and 500- mg regimens were 39 +/- 5 and 102 +/- 11 mg/l, respectively, obtained between 2 and 3 h after drug intake. The corresponding values for SBF, obtained later, between 2 and 12 h after drug intake, were 21 +/- 5 and 79 +/- 11 mg/l. As measured by the ratio of area under the concentration vs. time curve (SBF/S), fusidic acid penetration is 69-75%, whatever the dose. With either regime, the fusidic acid SBF and serum levels exceed the minimal inhibitory concentration of bacteria usually found in skin infections, especially Staphylococcus species. A dose of 250 mg twice a day appears sufficient to treat these infections and could be tested in clinical studies.
In a Danish multi-practice study the efficacy of erythromycin tablets (AbboticinR 500 mg tablets), fusidic acid cream (FucidinR cream), and placebo was compared in 86 patients (71 men and 15 women) with erythrasma.
The patients were treated ‘double-blind’ for 14 days with either active tablets + placebo cream, placebo tablets + active cream, or placebo tablets + placebo cream. The signs of erythrasma, i.e. colour intensity, demarcation, and scaling of the affected area, as well as degree of fluorescence under Wood's light, were recorded before treatment, after one and two weeks, and at follow-up four weeks later.
Cure/improvement was obtained in 77% of the cases in the erythromycin group, 87% in the fusidic acid group, and 42% in the placebo group.
There was no difference between the active preparations, whereas both were significantly better than placebo, P = 0.01.
The in vitro activity of teicoplanin and A16686, two new glycopeptide antibiotics was determined against 196 isolates of anaerobic bacteria. The activity of teicoplanin and A16686, in comparison with that of vancomycin, clindamycin, erythromycin and fusidic acid was 2 to 16 times higher against the gram positive anaerobes, namely, Propionibacterium acnes, Clostridium perfringens, Clostridium difficile, Clostridium species, Peptococcus species and Peptostreptococcus species. However, Bacteroides fragilis was resistant to teicoplanin and A16686 while Bacteroides melaninogenicus and Bacteroides bivius were found to be sensitive.
The pharmacokinetics of sodium fusidate were studied in eight healthy volunteers (five males and three females) aged 21 to 33 years (29.1 +/- 1.5), weight 46 to 79 kg (61.6 +/- 4.0 kg). First, the subjects were given 500 mg of sodium fusidate by infusion over two hours; secondly, one month later, the volunteers were given 500 mg of fusidate by infusion every eight hours for three days; thirdly, two 250 mg tablets of a new film coated formulation were administered as a single dose. Plasma concentrations of fusidate were measured by HPLC. Peak plasma concentrations reached at the end of the first and the last infusions were 52 +/- 5 mg/l and 123 +/- 12 mg/l respectively. The following mean pharmacokinetic parameters were obtained after single intravenous administration: elimination half-life 10 +/- 1 h, total clearance 22 +/- 2 ml/min and volume of distribution 0.30 +/- 0.04 l/kg. After repeated administration the half-life and the volume of distribution remained unchanged whereas total clearance was halved (11 +/- 1 ml/min). This leads to an experimental accumulation ratio (3.6 +/- 0.2) higher than the theoretical one (1.8 +/- 0.1; P less than 0.01). Consequently, mean trough and peak steady state plasma concentrations (81 +/- 9 and 123 +/- 12 mg/l respectively) are higher than those expected from the single dose kinetics (33 +/- 4 and 76 +/- 7 mg/l respectively). This dose regimen leads to concentrations well above the MIC for most sensitive strains.(ABSTRACT TRUNCATED AT 250 WORDS)
A total of 413 eligible patients took part in an observer-blind randomised multicentre clinical trial in order to compare the clinical and bacteriological efficacy of mupirocin (Bactroban) ointment with sodium fusidate (Fucidin) ointment for treating superficial skin infections seen in general practice. Mupirocin was applied twice daily and sodium fusidate thrice daily for a period of 7 days. Both treatments were similarly effective with 97% patients treated with mupirocin and 93% patients treated with sodium fusidate responding. Mupirocin was significantly more effective in the treatment of acute primary skin infections and in the treatment of a subgroup of patients with impetigo (P less than 0.01). Of the organisms detected before treatment began, 93% were not found after treatment with mupirocin compared with 89% after treatment with sodium fusidate. Staphylococcus aureus and/or beta-haemolytic streptococci appeared to be eliminated in significantly more patients treated with mupirocin (96%) compared with those treated with sodium fusidate (88%), (P = 0.03). Both treatments were well tolerated.
The efficacy and side effects of topical mupirocin (Bactroban) and fusidic acid (Fucidin) ointment were compared in a double-blind, randomized trial in 70 patients who came to the Dermatologic Clinic of L'Enfant Jésus Hospital with primary or secondary (or both) skin infections. Thirty-five patients were treated with mupirocin and 35 patients were treated with fusidic acid three times a day for seven days. Clinical and bacteriologic assessments were conducted before and after treatment. The efficacy of mupirocin, in terms of resolution and improvement of clinical signs and symptoms of infection, as well as of the elimination of infecting organisms, was similar to that of fusidic acid. Of 34 patients (1 could not be evaluated) treated with mupirocin, a clinical cure was achieved in 18, and significant improvement was demonstrated in 15. Similarly, of 35 patients treated with fusidic acid, a clinical cure was achieved in 18 and improvement occurred in 15. Bacteriologic cure rates were 97% (30 of 31 patients evaluated) in the mupirocin-treated group, compared with 87% (27 of 31 patients evaluated) in the fusidic acid-treated group. No side effects were observed in either treatment group. Because topical 2% mupirocin has little or no potential for irritation, systemic side effects, or cross-resistance with other antibiotics, its efficacy is likely to make this new compound a useful agent for the treatment of superficial skin infections.
Sodium fusidate ointment and mupirocin ointment were compared in 354 patients with superficial skin sepsis. The ointments were applied 3-times daily, or once daily when covered by a dressing, and the response assessed after 6 to 8 days. Both preparations proved effective clinically with 86% of patients responding. There was no difference between the two preparations in cases of primary infection (85% to both ointments), including a sub-group with impetigo (sodium fusidate 88% and mupirocin 84%), or secondary infection (sodium fusidate 81% and mupirocin 89%). Sodium fusidate ointment (98%) was significantly better (p less than 0.05) than mupirocin (82%) in patients with other superficial infections. Both ointments were equally effective in cases where Gram-positive, Gram-negative or mixed Gram-positive/Gram-negative bacteria were isolated. Adverse effects were reported in 1.0% of patients using sodium fusidate ointment and in 7.4% of patients using mupirocin ointment. The majority of complaints concerned the greasiness of mupirocin ointment.
The penetration into the horny layer and permeation through the skin of fusidic acid, incorporated in different bases, e.g., cream, ointment and a gel (Fucidine), was investigated in vitro in a penetration chamber, using human skin. Whereas the horny layer offers a marked barrier to penetration in normal skin, this barrier can be greatly reduced by damaging the horny layer by adhesive tape stripping. Fusidic acid showed penetration into the different layers of skin which was related to the duration of application, including the penetration chamber fluid, i.e., there was penetration of the entire skin thickness. In the presence of spontaneous changes in the horny layer, as in seborrhoeic warts and similar conditions, fusidic acid penetrated well into the deeper layers of the skin. Fusidic acid is thus a substance which permeates better in regions where the horny layer is damaged, and where it can attain high levels, which in practice are antimicrobial. Penetration into the skin is thus a function of damage to the horny layer and the quality of the horny layer itself. From this point of view the amount of absorption in dermatoses depends on the area of skin with damage to the horny layer. Penetration through normal skin can be disregarded.
Ninety-nine patients with secondarily infected eczema were allocated at random to receive 10-days' treatment with either 2% fusidic acid plus 0.1% betamethasone cream or 0.1% gentamicin plus 0.1% betamethasone cream. Both preparations were applied to the lesions twice daily and assessment of the signs and symptoms was carried out before, after 2 to 4 days, and after 7 to 12 days of treatment, severity being rated on a 4-point scale. Bacteriological tests were carried out before and after treatment. The results showed that the combination with fusidic acid was marginally superior in clinical effect. Staphylococcus aureus was the most commonly isolated pathogen from eczematous lesions (86%) and fusidic acid showed the lowest resistance rate (9%), followed by gentamicin (21%). Chloramphenicol, neomycin and tetracycline showed resistance rates from 48% to 59%.
Eighty-one patients with atopic dermatitis and contact dermatitis received a 1-week treatment with 0.1% betamethasone alone on one side and 0.1% betamethasone plus 2% fusidic acid on the other side. Clinically, the combination was marginally superior and in patient preference a significant difference in favour of the combination was recorded. Bacteriologically, the combination eliminated 67% of bacteria originally present in the skin lesions compared with 51% with steroid alone.
— Evidence is presented that the antibiotic substances sodium fusidate and fusidic acid are both capable of penetrating intact human skin at a rate similar to that seen with glucocorticoids. This is the first experimental in vitro evidence of the penetration of a topically applied antibiotic: the techniques employed depended on the measurement of C14-labelled material, and upon microbiological assay.
Although Staph. aureus resistant to fusidic acid can be selected in vitro and has been found in vivo following treatment, naturally occurring strains without previous exposure to the drug have not, so far, been reported. Four such strains were isolated in the area of the North West Surrey Group Laboratory between August and September 1965, and six at Hammersmith Hospital during the first four months of 1966. In two of these resistance to fusidic acid was very unstable and its loss was accompanied by loss of resistance to penicillin in the first and to tetracycline and kanamycin in the second, although this strain remained resistant to penicillin.
One-hundred and ten patients presenting to their General Practitioner with impetigo were given either Fucidin Ointment (sodium fusidate 2%) or Cicatrin Cream (neomycin sulphate 0.5%, bacitracin zinc 250 units per gram) on a blind, randomised basis. Additional systemic therapy was prescribed for 24 patients. The results indicate that 69% of patients receiving Fucidin Ointment were healed at 7 days compared with only 47% after Cicatrin Cream. Both preparations were generally well tolerated although one possible case of sensitization to Cicatrin Cream occurred.
In total, 256 patients with bacteriologically verified impetigo contagiosa were included in three double-blind, parallel group, randomized, multi-centre trials, where the efficacy of hydrogen peroxide cream (Microcid) was compared with that of fusidic acid cream/gel (Fucidin). The trials were performed at 47 centres in three countries, Sweden, Germany and UK, and the results are compiled in the present report. During the course of the 3-week treatment period, 92 patients out of 128 (72%) in the Microcid group were classified as healed, compared to 105 patients out of 128 (82%) in the Fucidin group. This difference was not statistically significant. The reduction in composite sign severity score (the sum of the score for erythema, vesiculation/bullae, weeping and crusting divided by four) in each separate study was 73%, 78% and 84% in the Microcid group and 85%, 85% and 84% in the Fucidin group. No statistically significant differences were found in the separate studies or when compiling the studies in a meta-analysis. When the patients had been classified as healed, beta-haemolytic streptococci were eliminated in all patients treated with Microcid cream. Since treatment started before the result of the bacteriology was known, another 135 patients with negative skin culture were enrolled in the trials, i.e. 391 patients were included in the safety analysis. Out of these, 23 patients reported the occurrence of adverse events, mainly classified as mild. In conclusion, Microcid cream has been documented as a topical alternative to fusidic acid in the treatment of impetigo.
To assess the changes in antibiotic resistances in Staphylococcus aureus, both methicillin-susceptible and methicillin-resistant strains, in Australia.
Retrospective review of data collected annually.
Twenty metropolitan teaching hospitals in the six States of Australia and the Australian Capital Territory from 1988 to 1994.
Changes in prevalence and resistance rates of methicillin-resistant S. aureus (MRSA) and methicillin-susceptible strains, based on antibiotic susceptibility testing of clinical isolates of S. aureus.
Prevalence of MRSA has remained constant on the eastern seaboard of Australia. A distinctive strain of MRSA emerged in Western Australia which had different antimicrobial susceptibilities. Resistances emerged in MRSA strains from eastern Australia, principally to ciprofloxacin and rifampicin, while resistance to fusidic acid remained stable and resistance to chloramphenicol significantly declined. Resistances in methicillin-susceptible strains remained fairly stable, except for a decline in resistance levels for tetracycline. High levels of resistance were seen to penicillin, moderate levels to erythromycin and low levels to trimethoprim and fusidic acid in methicillin-susceptible strains.
The continued high prevalence of and increasing resistance in MRSA in some Australian hospitals have meant that some strains are now untreatable with oral antibiotics.
Fusidic acid is an antibiotic that belongs to a group of its own, the fusidanes. The molecule has a steroid-like structure but does not possess any steroid activity. The structure is thought to be responsible for the steroid-like high penetration, and for the fact that no cross-resistance or cross-allergy has been seen with other antibiotics in routine clinical use. The anti-microbial activity of fusidic acid is specifically aimed at the most common skin pathogens, including Staphylococcus aureus, towards which it is one of the most potent antibiotics. The place of fusidic acid in dermatology is in the treatment of mild to moderately severe skin and soft-tissue infections, e.g. impetigo, folicullitis, erythrasma, furunculosis, abscesses and infected traumatic wounds, whereas it is of less use in conditions such as hidradenitis suppurativa, chronic leg ulcers, burns and pressure sores. The topical combinations of fusidic acid with either betamethasone or hydrocortisone are extremely useful in the treatment of atopic dermatitis/eczema whenever staphylococcal/secondary infection is suspected, and in more persistent cases of eczema where staphylococcal superantigen may be playing an important exacerbating role.
Skin and soft skin tissue infections are usually caused by Staphylococcus aureus and Streptococcus pyogenes. In vitro data show good activity of fusidic acid against staphylococci but the minimal inhibitory concentrations for streptococci are relatively high indicating marginal activity. A limited number of clinical trials have been performed using oral fusidic acid and although all have methodological problems the difference in susceptibility of these two organisms is apparent. The end of study cure rates for these studies were 91-99% for S. aureus and 75-85% for S. pyogenes. Topical therapy has been used in a number of forms and for different skin infections. Comparative studies have been conducted with mupirocin, trimethoprim/polymixin cream, hydrogen peroxide and combination steroid preparations. For most of these studies fusidic acid was equivalent to the comparator agent except where there was a proven S. pyogenes infection. Studies with topical fusidic acid have also been reported in specific disease states such as acne, erythrasma, and abscesses with good results.
Resistance to fusidic acid is determined by a number of mechanisms. The best described are alterations in elongation factor G, which appear in natural mutants that are harboured at low rates in normal populations of staphylococci (10(6) to 10(8)). Altered drug permeability has also been described, and appears to be plasmid-borne. Binding by chloramphenicol acetyltransferase type I and efflux are other described mechanisms of resistance whose prevalence is unclear. A large number of studies have examined rates of fusidic acid resistance in staphylococci. Most show low levels of resistance. Studies where high levels of resistance have been seen are from areas of the hospital where cross infection is common. Rates of resistance have tended to be slightly higher in methicillin-resistant strains of Staphylococcus aureus. Studies on the evolution of resistance have shown no major trends to the emergence of resistance. In one case this is despite increasing use of both systemic and topical fusidic acid over more than 24 years. Selection for resistant variants during treatment was recognised early in vitro and in vivo. However, evidence suggests that it does not occur at high frequency in clinical practice. Nevertheless, accumulated experience is that fusidic acid in combination with other agents results in less resistance emergence.