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Topical Antibiotic Pregnancy: Can be used during pregnancy and during breast-feeding, as systemic exposure after topical application is negligible; when breast-feeding, avoid applying to the breast

Fusidic Acid 2% Cream/Ointment

Brand names: Fucidin

Topical fusidic acid cream or ointment is a narrow-spectrum antistaphylococcal antibiotic applied to localised superficial skin infection such as impetigo and infected minor wounds.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Apply gently to the lesion — uncovered lesions: apply three or four times daily; covered lesions: less frequent applications may be adequate
Route: Topical (cutaneous use)
Frequency: Three or four times daily for uncovered lesions; less frequently for covered lesions
Source is the SPC for Fucidin 20 mg/g Cream (fusidic acid 2%). SPC §4.2 gives one posology headed 'Adults and Paediatric population' — no separate paediatric dose is stated and no per-kg dose applies; verify paediatric use against a children's formulary. No treatment duration or maximum dose is stated in §4.2. §4.4: bacterial resistance among Staphylococcus aureus has been reported with topical use, and extended or recurrent use may increase the risk of antibiotic resistance and of contact sensitisation. The cream contains butylhydroxyanisole, cetyl alcohol, potassium sorbate and polysorbate 60, which may cause local skin reactions or allergic reactions; butylhydroxyanisole may irritate the eyes and mucous membranes, so use with care near the eyes. Fire hazard: instruct patients not to smoke or go near naked flames — fabric (clothing, bedding, dressings) in contact with the product burns more easily.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • Hypersensitivity to the active substance or to any of the excipients

Side effects

  • Uncommon: dermatitis (including contact dermatitis and eczema), rash (various types, including generalised rash), pruritus and erythema
  • Uncommon: application site pain (including skin burning sensation) and application site irritation
  • Rare: hypersensitivity
  • Rare: angioedema, urticaria and blister
  • Rare: conjunctivitis
  • Overall frequency of undesirable effects in pooled clinical data (4724 patients on Fucidin cream or ointment) was 2.3%; frequency, type and severity in children are expected to be the same as in adults

Interactions

  • No interaction studies have been performed; interactions with systemically administered medicinal products are considered minimal as systemic absorption of topical fusidic acid is negligible

Clinical monograph

How it works

Fusidic acid inhibits bacterial protein synthesis by interfering with elongation factor G, preventing ribosomal translocation, and is particularly active against Staphylococcus aureus.

Prescribing in practice

  • Resistance emerges readily, so restrict topical use to short courses for localised infection and avoid repeated or prolonged application to limit selection of resistant staphylococci.
  • It is unsuitable as sole therapy for extensive or deep infection, which requires systemic antibiotics guided by culture.
  • Avoid application near the eyes unless an ophthalmic preparation is specifically indicated.

Monitoring

Monitor the treated area for clinical resolution and review the diagnosis if there is no improvement within a short defined course, in case of resistance or an alternative pathogen.

Counselling the patient

  • Apply a thin layer to the affected area only, for the short course prescribed, and do not continue once healed.
  • Wash your hands before and after applying, and avoid sharing towels to limit spread of infection.

Evidence & guidelines

UK antimicrobial stewardship guidance discourages widespread topical fusidic acid use because of well-documented staphylococcal resistance.

Reference: MHRA Drug Safety Update (Topical Fusidic Acid 2017); NICE CKS Impetigo; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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