Fusidic Acid Cream 2%: Indications and Application Regimen
Fusidic acid cream 2% is indicated for mild to moderately severe superficial bacterial skin infections caused primarily by Staphylococcus aureus, including impetigo, folliculitis, infected eczema, and infected traumatic wounds, applied 2-3 times daily for 7-14 days. 1, 2
Primary Indications
Fusidic acid cream 2% is specifically effective for:
- Impetigo - highly contagious superficial epidermal infection caused by β-hemolytic Streptococcus and/or S. aureus, particularly common in children 3, 1
- Folliculitis - superficial infection of hair follicles 1
- Infected atopic dermatitis/eczema - when staphylococcal secondary infection is suspected or confirmed 1, 4
- Infected traumatic wounds - superficial lacerations or abrasions with bacterial contamination 1
- Furunculosis - small, localized boils without extensive surrounding cellulitis 1
- Erythrasma - superficial bacterial skin infection 1
Application Regimen
- Apply fusidic acid 2% cream to the affected area 2-3 times daily 2, 5
- Treatment duration: 7-14 days depending on clinical response 2, 6
- The cream formulation is particularly suitable for weeping lesions or areas not requiring dry dressing 2
- For dry lesions requiring dressing coverage, fusidic acid ointment may be preferred over cream 2
Microbiological Activity
- Fusidic acid demonstrates potent activity against S. aureus (the most common skin pathogen), including methicillin-resistant strains (MRSA) 1, 4
- Also effective against other Gram-positive bacteria including Streptococcus species 1
- Resistance rates to fusidic acid remain stably low 4
- No cross-resistance with other antibiotics in routine clinical use 1
Important Limitations and When NOT to Use
Fusidic acid cream is NOT appropriate for:
- Simple abscesses or boils - incision and drainage is the primary treatment; antibiotics are not needed for simple, well-circumscribed abscesses 3
- Cellulitis or erysipelas - these deeper infections require systemic antibiotic therapy against Gram-positive bacteria 3
- Infections with systemic signs - presence of fever, hypotension, oliguria, or decreased mental alertness requires systemic antibiotics 3
- Extensive infections - hidradenitis suppurativa, chronic leg ulcers, burns, and pressure sores require systemic therapy 1
- Deep soft tissue infections - require systemic antibiotics 7
- Immunocompromised patients with significant infections - require systemic therapy 3
Combination Therapy Considerations
- Fusidic acid combined with topical corticosteroids (betamethasone or hydrocortisone) is extremely useful for infected atopic dermatitis/eczema where both antibacterial and anti-inflammatory effects are needed 1, 4
- The lipid-enriched cream formulation provides additional emollient and moisturizing benefits, particularly valuable in atopic-infected eczema 4
Clinical Efficacy
- Bacteriologic cure rates of 87-97% have been demonstrated in clinical trials 6
- Clinical cure or significant improvement achieved in 94-97% of patients with superficial skin infections 6
- Comparable efficacy to mupirocin for superficial infections, though recent evidence suggests fusidic acid may have superior activity against Propionibacterium acnes 5, 6