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13.10 Anti-infective skin preparations

13.10.1 Antibacterial preparations

      FUSIDIC ACID topical (for Gram +ve organisms) 
      METRONIDAZOLE topical (for anaerobes)
      MUPIROCIN for MRSA decolonisation
        POTASSIUM PERMANGANATE for infected eczema of the hands and feet
        SILVER SULFADIAZINE (for Gram -ve organisms)

Topical antibiotics should only be used short-term and for localised infections.

Burns

Silver sulfadiazine cream is used for infected burns and ulcers.

Exudative eczema

See section 13.5.1

Fungating tumours

Metronidazole gel is helpful for fungating tumours.

Impetigo

Mild impetigo may be treated with topical fusidic acid but resistance may develop if used alone for prolonged periods.  Oral flucloxacillin may be prescribed for extensive or bullous impetigo.

Leg ulcers

See the dressings formulary for local guidelines.

13.10.2 Antifungal preparations

1st        CLOTRIMAZOLE cream (can be purchased over the counter)
      ECONAZOLE cream (can be purchased over the counter)
2nd     TERBINAFINE cream
      KETOCONAZOLE 200mg twice daily for 5 days
      ITRACONAZOLE 100mg daily for 7 days is useful for pityriasis versicolor 

Tinea unguium should be treated with TERBINAFINE  250mg daily for up to 3 months, or ITRACONAZOLE 100mg daily for 7 days each month for 4-6 months.

13.10.4 Parasiticidal preparations

Scabies

1st        PERMETHRIN 

Aqueous preparations are preferable to alcoholic lotions.

All members of the household and close contacts should be treated.

Clothes and bedlinen should be washed at normal temperatures at time of treatment.

Head lice

1st line treatment - Meticulous combing with conditioner and a nit comb every 4 days for a minimum of 2 weeks 

      DIMETICONE
      PERMETHRIN
        MALATHION

Refer to Public Health guidelines for the treatment of head lice.

Crab lice

1st        MALATHION 

An aqueous preparation should be applied to all parts of the head and body for 12 hours or overnight; a second treatment is needed after 7 days to kill lice emerging from surviving eggs.

Alcoholic lotions are not recommended due to irritation of excoriated skin and genitalia.

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