A topical quadruple combination preparation containing a corticosteroid (Beclometasone dipropionate), an aminoglycoside antibiotic (Neomycin sulphate), an imidazole antifungal (Clotrimazole), and an antiseptic preservative (Chlorocresol). It is primarily indicated for the treatment of mixed dermatological infections where inflammation, bacterial, and fungal components coexist, commonly seen in tropical climates like India. It provides broad-spectrum coverage against common skin pathogens.
Adult: Apply a thin layer to the affected area 2 to 3 times daily. Duration should be limited to a maximum of 2 weeks for most indications unless directed by a physician.
Note: 1. Wash and dry the affected area gently. 2. Take a small amount on a clean fingertip. 3. Apply a thin, even film and rub in gently until absorbed. 4. Wash hands before and after application unless hands are the treatment site. 5. Do not cover with occlusive dressings unless specifically advised. 6. Do not use for more than the prescribed duration.
This combination exerts a multifaceted action: 1) Beclometasone suppresses inflammation, itching, and cellular proliferation by modulating gene expression. 2) Neomycin inhibits bacterial protein synthesis. 3) Clotrimazole disrupts fungal cell membrane ergosterol synthesis. 4) Chlorocresol denatures proteins and disrupts microbial cell walls, providing antiseptic action and preservative efficacy.
Pregnancy: Category C (US FDA). Corticosteroids have been shown to be teratogenic in animals. Topical use may result in low systemic absorption. Use only if the potential benefit justifies the potential risk to the fetus, especially in the first trimester. Avoid large amounts or long duration.
Driving: No effect on driving ability.
| Other Topical Corticosteroids | Additive risk of local and systemic adverse effects (atrophy, HPA suppression). | Major |
| Other Aminoglycosides (Systemic e.g., Gentamicin, Amikacin) | Increased risk of ototoxicity and nephrotoxicity if neomycin is significantly absorbed. | Major |
| Loop Diuretics (e.g., Furosemide) | Potentiates the risk of ototoxicity with absorbed neomycin. | Moderate |
| Neuromuscular Blocking Agents | Neomycin can potentiate neuromuscular blockade, leading to respiratory depression. | Major |
| CYP3A4 Inhibitors (e.g., Ketoconazole, Itraconazole, Clarithromycin) | May increase systemic levels of beclometasone if absorbed, increasing steroid side effects. | Moderate |
Same composition (Beclometasone (0.025% w/w) + Neomycin (0.5% w/w) + Clotrimazole (1% w/w) + Chlorocresol (0.1% w/w)), different brands: