A fixed-dose combination topical preparation containing a corticosteroid (Beclometasone dipropionate), an aminoglycoside antibiotic (Neomycin sulphate), and an imidazole antifungal (Clotrimazole). It is primarily indicated for the treatment of mixed fungal and bacterial infections of the skin with associated inflammation and pruritus, commonly seen in conditions like infected eczema, infected intertrigo, and infected dermatophytosis. This combination provides broad-spectrum coverage against common dermatophytes, Candida, and Gram-positive/negative bacteria while simultaneously reducing inflammation, itching, and erythema.
Adult: Apply a thin layer to the affected area 2 to 3 times daily. Duration should be limited to a maximum of 2-4 weeks.
Note: 1. Wash and dry the affected area gently. 2. Take a small amount of cream on clean fingertips. 3. Apply a thin film and rub in gently until absorbed. 4. Wash hands before and after application, unless hands are the treatment area. 5. Do not cover with occlusive dressings unless specifically directed by a physician. 6. Avoid contact with eyes, nose, mouth, and mucous membranes.
The combination exerts a triple action: 1) Beclometasone (a medium-potency corticosteroid) binds to glucocorticoid receptors, leading to the synthesis of anti-inflammatory proteins (lipocortins) and inhibition of pro-inflammatory mediators (prostaglandins, leukotrienes, cytokines), thereby reducing inflammation, erythema, and pruritus. 2) Neomycin is a bactericidal aminoglycoside that binds to the 30S ribosomal subunit of susceptible bacteria, inhibiting protein synthesis. It is effective against common skin pathogens like Staphylococcus aureus and Escherichia coli. 3) Clotrimazole is a fungistatic/fungicidal imidazole that inhibits the synthesis of ergosterol, a vital component of the fungal cell membrane, by inhibiting the cytochrome P450-dependent enzyme lanosterol 14-α-demethylase. This leads to increased membrane permeability and cell death of dermatophytes (Trichophyton, Microsporum, Epidermophyton) and Candida species.
Pregnancy: Category C (US FDA). Topical corticosteroids, including beclometasone, can be absorbed in amounts sufficient to produce systemic effects. Use only if the potential benefit justifies the potential risk to the fetus. Avoid large amounts or long-term use. Neomycin and clotrimazole topical use is generally considered low risk, but safety is not fully established.
Driving: No effect on driving ability.
| Other Topical Corticosteroids (e.g., Clobetasol, Mometasone) | Increased risk of local and systemic steroid side effects. | Major |
| Other Topical Aminoglycosides (e.g., Gentamicin cream) | Increased risk of ototoxicity and nephrotoxicity if absorbed. | Moderate |
| Systemic Aminoglycosides (e.g., Amikacin, Gentamicin IV) | Additive risk of ototoxicity and nephrotoxicity. | Major |
| Potassium-depleting diuretics (e.g., Furosemide) | Enhanced hypokalemia risk if significant systemic absorption of corticosteroid occurs. | Moderate |
Same composition (Beclometasone (0.025% w/w) + Neomycin (0.5% w/w) + Clotrimazole (1% w/w)), different brands: