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13.10.1 - 13.10.2 Antiviral, parasiticidal, minor cuts and abrasions

13.10.1 Antibacterial Preparations

Mupirocin ointment (Bactroban)
Silver Sulfadiazine cream (Flamazine)
Fucidic acid cream, gel, ointment
Metronidazole gel 0.75%
Polymyixin (Polyfax Ointment)


1. Remember not all skin conditions that are oozing, crusted or characterised by pustules are infected.

2. Topical antibiotics should be avoided in leg ulcers, unless used in short courses for defined infection; treatments of bacterial colonisation are generally inappropriate.

3. To minimise the development of resistant organisms it is advisable to limit the choice to those not used systematically. Neomycin may cause sensitisation.

4. Silver sulfadiazine is especially useful for infected burns; it has good activity against Gram-negative organisms, including Pseudomonas. It is not appropriate for treatment of minor burns where the skin is not broken. It is relatively expensive and should be limited to short term use.

5. Mupirocin has good activity against Gram positive organisms, including methicillin-resistant staphylococci. Absorption through broken skin can be significant and bacterial resistance has been reported. It is expensive. For these reasons it should only be used where recommended by Microbiology.

6. Medi-Honey Barrier Cream has replaced Flamazine and 50/50 as the second line management of Incontinence associated moisture damage


13.10.2 Antifungal Preparations

Benzoic acid compound ointment
Clotrimazole cream, solution, dusting powder
Ketoconazole cream
Miconazole cream
Nystaform cream
Terbinafine cream
Amorolfine nail lacquer


1. Cutaneous fungal infections are most commonly due to dermatophytes (ringworm), candida and pityrosporum species. Fungal nail infections (onychomycosis) are mostly due to dermatophytes. Rarer cases of onchomycosis include candida and unusual moulds. It is recommended that whenever dermatophyte infection is suspected, skin scrapings and nail clippings are submitted for mycological confirmation prior to treatment (see section 5.2).

2. Most skin ringworm infections, including tinea pedis can be treated adequately with topical preparations including imidazole (e.g. chlotrimazole) and terbinafine. Tinea manum and generalised tinea corporis in adults are best treated with oral terbinafine (see section 5.2). The recommended treatment for tinea capitis in children is still griseofulvin 10mg/kg daily, as oral terbinafine is not yet licensed for children.

3. Onychomycosis responds best to oral terbinafine Pulsed oral itraconazole 400mg per day 1 week on, 3 weeks off for two months fingernails, and three months for toenails is also effective.

4. Amorolfine nail lacquer is only recommended for treating superficial white onychomycosis.

5. Candidal skin infections respond to topical imidazoles and nystatin. Combination with a weak corticosteroid may be of use in treatment of eczematous intertrigo.

6. Pityriasis versicolor may be treated with daily ketoconazole shampoo (see section 13.9) or oral itraconazole (see page 5.2). Patients must be informed that repigmentation of infected skin will only occur with subsequent sun exposure.

For link to BNF section: 13.10 Anti-infective skin preparations