Are there antibacterial, antifungal, and steroid creams (Rx) available in Canada?

Combination Antibacterial/Antifungal/Steroid Creams Available in Canada

Yes, there are several combination antibacterial/antifungal/steroid creams available by prescription in Canada, such as Kenacomb (containing an antifungal, antibiotics active against gram-positive and gram-negative organisms, and a steroid). 1

Available Combination Products

Triple-Combination Products

• Kenacomb: Contains an antifungal, antibiotics effective against both gram-positive and gram-negative bacteria, and a corticosteroid 1
  • Particularly useful for inflamed skin infections with mixed bacterial and fungal components

Dual-Combination Products

• Antifungal + Steroid combinations:
  • Clotrimazole/betamethasone combinations
  • Miconazole/hydrocortisone combinations
  • Terbinafine/steroid combinations

Clinical Applications

When to Use Combination Products

• Inflamed fungal infections: When inflammation accompanies fungal infection, causing pruritus and discomfort 2
• Mixed infections: When both bacterial and fungal pathogens are suspected
• Inflammatory dermatoses with secondary infection: Such as eczema with bacterial or fungal superinfection

Advantages of Combination Products

1. Simultaneous treatment of infection and inflammation
2. Reduced application frequency compared to separate products
3. Improved patient compliance due to simplified regimen
4. Faster symptom relief of pruritus and inflammation 2

Important Considerations and Cautions

Potential Disadvantages

• Higher cost compared to single-agent products 3
• Potentially lower effectiveness for treating the fungal component compared to single-agent antifungals 3, 4
• Risk of inappropriate use in conditions where one component is not needed

Safety Concerns

• Steroid-related adverse effects:
  • Skin atrophy with prolonged use
  • HPA axis suppression with extensive application 5
  • Masking of infection progression
• Oil-based creams and suppositories may weaken latex condoms and diaphragms 1

Treatment Recommendations

For Inflamed Superficial Fungal Infections

• Short-term use (1-2 weeks) of combination products is appropriate for initial treatment 1
• Follow with antifungal-only treatment to complete the course if inflammation resolves but infection persists

For Bacterial Skin Infections with Inflammation

• Topical antibacterial-steroid combinations for localized infections
• Consider oral antibiotics for more extensive infections with appropriate topical therapy 1

For Candidal Infections

• Combination antifungal-steroid products may be used for short-term management of symptomatic vulvovaginal candidiasis 1
• Single-agent antifungals are preferred for uncomplicated cases 1

Follow-Up Recommendations

• Reassess after 2 weeks of treatment 1
• If no improvement or worsening occurs, consider:
  • Obtaining bacterial/fungal cultures
  • Changing to a different antifungal class
  • Referral to a specialist 1

Common Pitfalls to Avoid

• Prolonged use of combination products containing steroids (limit to 2 weeks)
• Using on large body surface areas without monitoring for systemic absorption 5
• Treating without confirming diagnosis (microscopy or culture may be needed for persistent cases)
• Continuing combination therapy after inflammation resolves

By following these guidelines, healthcare providers can appropriately prescribe combination antibacterial/antifungal/steroid creams for patients in Canada when clinically indicated, while minimizing potential adverse effects.