Is it reasonable to add oral Septra (trimethoprim/sulfamethoxazole) and topical Fucibet (fusidic acid and betamethasone) to cefixime for worsening infected contact dermatitis?

From the Guidelines

Adding oral Septra (trimethoprim/sulfamethoxazole) and topical Fucibet (fusidic acid and betamethasone) to cefixime for worsening infected contact dermatitis is generally not recommended. Instead, it's preferable to choose one appropriate antibiotic regimen rather than combining multiple antibiotics. For infected contact dermatitis, a single antibiotic with good skin coverage such as cephalexin 500mg four times daily for 7-10 days would be appropriate, as suggested by general principles of treating skin and soft tissue infections 1. If MRSA is suspected, then Septra DS (one tablet twice daily) would be a reasonable choice, given its effectiveness against MRSA 1. The topical Fucibet can be beneficial as it combines an antibiotic (fusidic acid) with a corticosteroid (betamethasone) to address both infection and inflammation, applied thinly to affected areas 2-3 times daily for 7-10 days. Using multiple systemic antibiotics simultaneously (cefixime plus Septra) increases the risk of adverse effects, drug interactions, and antimicrobial resistance without providing significant additional benefit, as noted in guidelines for managing skin and soft tissue infections 1. The underlying contact dermatitis should also be addressed by:

• Identifying and avoiding the triggering allergen
• Using gentle skin care
• Considering oral antihistamines for itch relief If the infection doesn't improve within 48-72 hours of appropriate therapy, reevaluation is necessary to consider culture-guided therapy or alternative diagnoses.

From the Research

Treatment of Infected Contact Dermatitis

The use of oral Septra (trimethoprim/sulfamethoxazole) and topical Fucibet (fusidic acid and betamethasone) in addition to cefixime for worsening infected contact dermatitis is a complex decision.

• The diagnosis and management of contact dermatitis typically involve identifying and avoiding the causative substance, and using topical steroids for localized acute allergic contact dermatitis lesions 2.
• Cefixime is an orally active cephalosporin with a broad spectrum of antibacterial activity, but it has little activity against Staphylococcus aureus, which is a common cause of skin infections 3.
• Topical antibiotics, including those containing neomycin and bacitracin, can cause allergic contact dermatitis, and their use should be avoided in postoperative wound care 4.
• Fusidic acid is a potent antibiotic against Staphylococcus aureus and is useful in the treatment of mild to moderately severe skin and soft-tissue infections, including those caused by this bacterium 5.
• The combination of fusidic acid with betamethasone is useful in the treatment of atopic dermatitis/eczema with suspected staphylococcal/secondary infection 5.

Considerations for Treatment

When considering the addition of oral Septra and topical Fucibet to cefixime for worsening infected contact dermatitis, the following points should be taken into account:

• The potential for allergic contact dermatitis to topical antibiotics, including neomycin and bacitracin, and the need to avoid their use in certain cases 4.
• The efficacy of cefixime against gram-negative pathogens, but its limited activity against Staphylococcus aureus 3, 6.
• The usefulness of fusidic acid in the treatment of skin and soft-tissue infections caused by Staphylococcus aureus, and its potential as a component of topical Fucibet 5.
• The importance of identifying and avoiding the causative substance in contact dermatitis, and the role of topical steroids in the treatment of localized acute allergic contact dermatitis lesions 2.