Facid

• Approved Indications:
• Skin and soft tissue infections caused by Staphylococcus aureus, including:
• Impetigo
• Infected eczema
• Folliculitis
• Minor wound infections
• Osteomyelitis, particularly due to S. aureus, including methicillin-resistant strains (MRSA)
• Septic arthritis of staphylococcal origin
• Staphylococcal bacteremia and endocarditis (adjunct therapy)
• Pneumonia caused by S. aureus (adjunct therapy)
• Ophthalmic infections such as conjunctivitis and blepharitis (topical use)
• Clinically Accepted Off-label Uses:
• Nasal carriage eradication of Staphylococcus aureus
• Prophylaxis of surgical site infections in high-risk patients
• Treatment of acne vulgaris in combination regimens

• Route: Oral, topical (cream/ointment), ophthalmic (eye drops/ointment), intravenous (in some regions)
• Oral:
• Adults: 500 mg every 8 hours (total 1.5 g/day), duration 7–14 days based on infection severity
• Children:
• 1–5 years: 250 mg every 8 hours
• 6–12 years: 500 mg every 8 hours
• Under 1 year: 20 mg/kg/day divided into three doses
• Topical:
• Apply to affected area 2–3 times daily for 7–10 days
• Ophthalmic:
• 1 drop into affected eye(s) twice daily for 7 days
• Intravenous:
• 500 mg every 8–12 hours (where available), often combined with other antibiotics for serious infections
• Special Populations:
• Elderly: No specific dose adjustment; monitor liver function
• Renal impairment: No dose adjustment generally necessary
• Hepatic impairment: Use cautiously; monitor liver function tests; dose reduction may be required

Sodium fusidate inhibits bacterial protein synthesis by binding to elongation factor G (EF-G) on the ribosome. This prevents translocation during translation, effectively halting peptide chain elongation. It is primarily bacteriostatic but may exhibit bactericidal activity against Staphylococcus aureus, including methicillin-resistant strains, by disrupting bacterial growth and replication.

• Absorption: Well absorbed orally with approximately 91% bioavailability
• Distribution: Widely distributed; penetrates bone, soft tissues, and bodily fluids effectively; plasma protein binding ~95%
• Metabolism: Primarily hepatic via hydroxylation and acetylation
• Half-life: 5–6 hours; may be prolonged in hepatic impairment
• Excretion: Mainly biliary and fecal; minimal renal elimination
• Onset: Therapeutic plasma levels reached within 1–2 hours post-dose

• Pregnancy: No assigned FDA category. Animal studies do not demonstrate teratogenicity, but human data are limited. Use only if clearly needed.
• Lactation: Excreted in small amounts in breast milk. Use with caution; benefits should outweigh risks. Monitor infants for adverse effects.

• Primary Class: Antibiotic
• Subclass: Fusidane steroid antibiotic

• Hypersensitivity to sodium fusidate or any formulation components
• Severe hepatic dysfunction
• Neonates at risk of kernicterus
• Concurrent use with statins (e.g., simvastatin, atorvastatin) due to risk of severe muscle toxicity

• Monitor liver function during treatment, especially in hepatic impairment
• Avoid co-administration with statins due to increased risk of rhabdomyolysis
• Prolonged or repeated use may promote resistance
• Use topical and ophthalmic preparations only as directed to avoid irritation or secondary infections
• Discontinue therapy if severe allergic reactions occur

• Common: Nausea, vomiting, abdominal discomfort, diarrhea; local irritation with topical or ophthalmic use
• Serious (rare): Hepatotoxicity, elevated liver enzymes, hypersensitivity reactions, rhabdomyolysis (with statins), Stevens-Johnson syndrome (very rare)
• Timing: Usually onset within days of therapy initiation; severity may increase with prolonged use

• Statins: Contraindicated; increased risk of rhabdomyolysis
• Oral anticoagulants: Enhanced anticoagulant effect; monitor INR
• CYP3A4 substrates: Sodium fusidate inhibits CYP3A4, increasing plasma levels of drugs metabolized by this enzyme
• Hepatotoxic drugs: Co-administration may increase liver toxicity risk

• Recommendations emphasize cautious use to prevent resistance, particularly limiting topical use duration
• Continued monitoring of S. aureus resistance patterns supports reserved use for confirmed infections or combination therapy
• Guidelines advise against concurrent use with statins and recommend liver function monitoring

• Store oral tablets and suspensions at 20°C to 25°C (68°F to 77°F), protected from moisture and light
• Topical creams/ointments: store below 25°C, avoid freezing
• Ophthalmic preparations: refrigerate at 2°C to 8°C; discard after 28 days of opening
• Keep all forms out of reach of children and do not use past expiration date