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Topical Antibiotic Pregnancy: Caution — limited data on topical use; avoid large-area application

Fusidic Acid 2% Cream/Ointment

Brand names: Fucidin

Adult dose

Dose: Apply thinly 3–4 times daily
Route: Topical
Frequency: Three to four times daily
Max: Limit to 2 weeks (resistance risk)
First-line topical for impetigo, infected eczema, minor infected wounds, and superficial skin infections with Staphylococcus aureus. Do not use as monotherapy in MRSA. Fusidic acid resistance is increasing — do not prescribe without clinical indication.

Paediatric dose

Route: Topical
Frequency: Three to four times daily
Max: 2 weeks maximum
Same as adult — apply thinly. Safe in children including infants. Fucidin H (with hydrocortisone 1%) used for infected inflammatory skin conditions.

Dose adjustments

Renal

No adjustment for topical use.

Hepatic

Systemic fusidic acid hepatotoxic — topical use has minimal systemic absorption.

Clinical pearls

  • MHRA guidance: limit topical fusidic acid to 2 weeks and use with a corticosteroid (Fucidin H) when prescribing for infected eczema to reduce resistance risk
  • Do NOT use on large burn surfaces — risk of systemic absorption and hepatotoxicity
  • Resistance in S. aureus increasing — consider swab and sensitivities for recurrent infections

Contraindications

  • Hypersensitivity to fusidic acid

Side effects

  • Local irritation
  • Contact dermatitis (rare)
  • Resistance if prolonged use
  • Systemic absorption minimal but possible on large wound areas

Interactions

  • Warfarin (systemic fusidic acid increases INR — topical: clinically insignificant)
  • Statins: if using systemic fusidic acid — suspend statin (rhabdomyolysis risk)

Monitoring

  • Clinical response at 1 week
  • Signs of local allergy or worsening infection

Reference: BNFc; BNF 90; MHRA Drug Safety Update (Topical Fusidic Acid 2017); NICE CKS Impetigo. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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