Facid BT

Fusidic acid combined with betamethasone is used for treating inflammatory skin conditions complicated by bacterial infection.

Approved Indications:

• Infected Eczema / Dermatitis: Moderate to severe eczema with secondary bacterial infection, particularly caused by Staphylococcus aureus.
• Psoriasis with Superimposed Infection: Plaque psoriasis exhibiting signs of bacterial infection and inflammation.
• Other Superficial Skin Infections: Where inflammation and infection coexist, e.g., impetiginized dermatitis or localized pyoderma.

Off-label / Clinically Accepted Uses:

• Certain allergic dermatitis or contact dermatitis with secondary infection.
• Inflammatory skin lesions resistant to monotherapy with topical corticosteroids or antibiotics alone.

Topical Use (Cream/Ointment):

• Apply a thin layer to the affected area 2–3 times daily.
• Duration: Usually 7–14 days, depending on severity and clinical response.
• Avoid prolonged use to prevent steroid-related adverse effects.

Special Populations:

• Pediatrics: Use the lowest effective dose for the shortest possible duration. Avoid occlusive dressings unless specifically advised.
• Elderly: Standard topical dosing; monitor for skin thinning or local adverse effects.
• Renal/Hepatic Impairment: No dose adjustment required for topical application.

Administration Route: Topical (cream or ointment only).

• Fusidic Acid: Inhibits bacterial protein synthesis by binding to elongation factor G (EF-G) on the ribosome, preventing translocation of tRNA and mRNA, which halts bacterial growth. Primarily effective against Gram-positive organisms like Staphylococcus aureus.
• Betamethasone: A potent corticosteroid that binds to glucocorticoid receptors, modulating gene expression to reduce inflammation, vasodilation, and immune cell recruitment. This combination provides simultaneous anti-inflammatory and antibacterial effects, rapidly alleviating both infection and inflammatory symptoms.

Topical Application:

• Absorption: Minimal systemic absorption; higher absorption may occur on inflamed or broken skin.
• Distribution: Primarily localized to skin; systemic distribution negligible.
• Metabolism: Minimal systemic metabolism; corticosteroid absorbed is metabolized hepatically.
• Elimination: Fusidic acid largely remains in the stratum corneum; minor absorbed fraction excreted in urine and bile. Betamethasone metabolized hepatically, excreted in urine.
• Onset: Relief of inflammation often within 24–48 hours; antibacterial effects evident over several days.

• Pregnancy: Category C (corticosteroid component). Topical use generally considered low risk if applied in small amounts for short durations. Avoid extensive or prolonged use.
• Lactation: Topical use unlikely to cause adverse effects in nursing infants. Avoid application to the breast. Monitor infants if significant systemic absorption occurs.

• Primary Class: Combination topical therapy
• Subclass: Antibiotic + Corticosteroid

• Known hypersensitivity to fusidic acid, betamethasone, or excipients.
• Viral, fungal, or tuberculosis skin infections unless specifically indicated.
• Rosacea, perioral dermatitis, or acne vulgaris (due to corticosteroid component).

• High-risk Groups: Pediatric patients, pregnant or breastfeeding women, elderly with thin skin.
• Corticosteroid-related Risks: Skin atrophy, striae, telangiectasia with prolonged use.
• Resistance Risk: Avoid prolonged or unnecessary use to prevent bacterial resistance.
• Monitoring: Observe for local irritation, worsening infection, or systemic corticosteroid effects.
• Early Signs of Severe Adverse Events: Persistent redness, pustules, or allergic reactions warrant discontinuation.

Common:

• Skin irritation, burning, stinging, or itching at the application site
• Dryness or peeling of skin

Serious / Rare:

• Secondary fungal infections due to corticosteroid-induced immunosuppression
• Allergic dermatitis or rash
• Skin thinning, striae, telangiectasia with prolonged use

Timing & Dose Dependence:

• Local side effects often appear within days.
• Severity increases with prolonged use or application under occlusion.

• Topical Therapy: Minimal systemic drug interactions.
• Systemic Absorption: Rare interactions with CYP3A4 substrates if significant corticosteroid absorption occurs.
• Other Topical Medications: Avoid concurrent use of other potent topical corticosteroids on the same area to prevent additive adverse effects.

• Current guidelines emphasize limiting duration to 1–2 weeks to prevent corticosteroid-related adverse effects and reduce fusidic acid resistance.
• Recommended for inflammatory skin infections where monotherapy with either antibiotic or corticosteroid alone is insufficient.
• Topical fusidic acid should not be used as prophylaxis to reduce the risk of antimicrobial resistance.

• Store at 20°C to 25°C, protected from light and moisture.
• Keep container tightly closed.
• Do not freeze.
• Discard if past expiry or if consistency changes.