Fungistat

• Treatment of inflammatory dermatoses complicated by secondary bacterial and/or fungal infections, such as:
• Eczematous dermatitis with infection
• Superficial bacterial skin infections (caused by susceptible organisms)
• Mixed fungal and bacterial infections of the skin (e.g., candidiasis with bacterial superinfection)
• Intertrigo and other moist skin lesions prone to infection
• Off-label: Occasionally used in minor wound infections or otitis externa under specialist guidance.

• Route: Topical application (cream, ointment, or lotion)
• Adults and Children: Apply a thin film to the affected area two to three times daily.
• Duration: Typically 7 to 14 days, or as directed by a healthcare provider. Prolonged use is discouraged.
• Special Populations: Use cautiously in infants and elderly; avoid use on large surface areas or broken skin unless advised.
• Administration Notes: Clean and dry the affected area prior to application. Avoid contact with eyes, mucous membranes, and open wounds.

This combination preparation works via multiple mechanisms:

• Triamcinolone: A corticosteroid that suppresses inflammation by inhibiting phospholipase A2, reducing prostaglandin and leukotriene synthesis.
• Neomycin: An aminoglycoside antibiotic that binds bacterial 30S ribosomal subunits, inhibiting protein synthesis and exerting bactericidal activity against gram-negative and some gram-positive bacteria.
• Nystatin: A polyene antifungal that binds ergosterol in fungal cell membranes, increasing permeability and causing fungal cell death.
• Gramicidin: A polypeptide antibiotic forming ion channels in bacterial membranes, disrupting ion gradients, mainly effective against gram-positive bacteria.
  Together, these agents reduce inflammation and eradicate bacterial and fungal pathogens in superficial skin infections.

• Minimal systemic absorption when applied to intact skin.
• Components are primarily active locally at the site of application.
• Topical corticosteroid is metabolized locally and systemically after absorption; antibiotics and antifungals have negligible systemic metabolism due to minimal absorption.
• Excretion occurs mainly via hepatic metabolism (steroids) and elimination of unchanged drug in feces and urine (minimal).

• Pregnancy: Category C for topical corticosteroids; use only if benefits outweigh risks. Neomycin and nystatin topical use is considered relatively safe; however, data are limited.
• Lactation: Limited data; use with caution and avoid application on the breast during breastfeeding.

• Combination topical corticosteroid, antibiotic, and antifungal agent.

• Known hypersensitivity to any component (triamcinolone, neomycin, nystatin, gramicidin, or excipients).
• Viral skin infections (e.g., herpes simplex, varicella).
• Tuberculous or syphilitic skin infections.
• Fungal infections without bacterial involvement, unless antifungal included.
• Perioral dermatitis or rosacea.
• Application on open wounds or severe burns.

• Avoid prolonged use to prevent skin atrophy, striae, and systemic corticosteroid effects.
• Monitor for allergic contact dermatitis, especially neomycin hypersensitivity.
• Avoid application near eyes to prevent steroid-induced glaucoma or cataracts.
• Use with caution on large areas or broken skin.
• Risk of secondary infections due to immunosuppression from corticosteroid.
• Not suitable for deep or systemic infections.

• Common: Local irritation, burning, itching, dryness.
• Rare/Serious: Allergic contact dermatitis, skin thinning, telangiectasia, hypopigmentation, secondary infections.
• Systemic side effects are rare but possible with excessive use.

• Minimal systemic interactions due to topical use.
• Avoid concurrent use with other topical corticosteroids or antibiotics unless prescribed.
• Avoid occlusive dressings unless advised, to prevent increased absorption.

• Emphasis on limiting duration of use to reduce corticosteroid-related adverse effects and antibiotic resistance.
• Allergy testing recommended in cases of suspected neomycin hypersensitivity.
• Preference for monotherapy when appropriate to avoid resistance development.

• Store at 20°C to 25°C (68°F to 77°F).
• Protect from heat, moisture, and direct sunlight.
• Keep container tightly closed.
• Do not freeze.