What are the indications for fusidic acid cream?

Indications for Fusidic Acid Cream

Fusidic acid cream is primarily indicated for the treatment of bacterial skin infections, particularly those caused by Staphylococcus aureus, including methicillin-resistant strains (MRSA), and other Gram-positive bacteria. 1

Primary Indications

• Impetigo: Fusidic acid cream is effective for treating impetigo, showing similar cure rates to mupirocin (RR, 1.03; 95% CI, 0.95-1.11) 2
• Outpatient skin and soft tissue infections (SSTI): Recommended as a treatment option for outpatient management of skin infections in adults (500 mg PO q8-12h or 750 mg q12h) and children 2
• Infected atopic dermatitis/eczema: Particularly useful in patients with infected eczema due to its dual antimicrobial activity and emollient properties when formulated in a lipid-enriched cream 3
• Folliculitis: Effective against superficial bacterial follicular infections 1
• Secondary bacterial infections: Used to treat secondary bacterial infections complicating other skin conditions 1

Antimicrobial Spectrum

• Highly effective against:
  • Staphylococcus aureus (including MRSA and penicillin-resistant strains) 1
  • Staphylococcus epidermidis 1
  • Streptococcus pyogenes 1
  • Propionibacterium acnes 1
  • Corynebacteria 1
  • Clostridia 1

Specific Formulations and Applications

• Standard formulation: 2% fusidic acid cream for general skin infections 4
• Combination formulations:
  • With corticosteroids (e.g., Fucidin H® - hydrocortisone 1% + fusidic acid 2%) for infected inflammatory dermatoses 2
  • With betamethasone (Fucicort® - betamethasone valerate 0.1% + fusidic acid 2%) for more potent anti-inflammatory effect in infected inflammatory skin conditions 2

Special Clinical Applications

• Impetiginized scabies: Combination of 5% permethrin with 2% fusidic acid cream has shown superior efficacy compared to permethrin alone (95% vs. 35% efficacy at day 14) 5
• Alternative treatment for Clostridioides difficile infection: Suggested as an alternative when vancomycin, metronidazole, or fidaxomicin are not available (weak recommendation/low evidence quality) 2

Advantages of Fusidic Acid Cream

• Penetration: Reaches high antimicrobial concentration in deep skin layers after topical application on both intact and damaged skin 1
• Low resistance risk: Maintains low resistance rates even in MRSA strains 1
• Low sensitization potential: Has very low risk of contact sensitization compared to other topical antibiotics 1
• Selective spectrum: Minimizes cross-resistance with other antibiotics 1

Practical Considerations

• Application frequency: Typically applied 2-3 times daily 4
• Duration of treatment: Usually 7-14 days for most bacterial skin infections 2
• Formulation selection:
  • Cream formulation is particularly suitable for lesions not requiring dressings 4
  • Ointment formulation may be preferred when dressings are applied 4

Cautions and Limitations

• Resistance development: While resistance rates are generally low, inappropriate or prolonged use may contribute to resistance 1
• Not first-line for C. difficile infection: Should only be used for CDI when standard treatments are unavailable 2

Fusidic acid cream represents an important topical antibiotic option for skin infections, particularly those caused by staphylococci, with the advantages of good tissue penetration, low resistance rates, and minimal sensitization potential.