1. Clinical Overview
A fixed-dose combination topical preparation containing a corticosteroid (Beclometasone), an aminoglycoside antibiotic (Neomycin), and an imidazole antifungal (Clotrimazole). It is primarily indicated for the treatment of mixed inflammatory, bacterial, and fungal skin infections, particularly in conditions like infected eczema, dermatitis, and intertrigo. This combination provides broad-spectrum coverage against common skin pathogens while reducing inflammation and pruritus.
| Onset | Duration | Bioavailability |
|---|---|---|
| Anti-inflammatory and antipruritic effects of Beclometasone are typically noticeable within 24-48 hours. Antimicrobial effects begin upon application. | Local effects persist for the duration the cream remains on the skin. Systemic absorption is minimal with topical use. | Topical bioavailability is variable and depends on skin integrity, site of application, and occlusion. Systemic absorption is generally low (<5%) for all components on intact skin but can increase significantly on damaged skin or under occlusion. |
2. Mechanism of Action
The combination works synergistically: Beclometasone suppresses inflammation, immune response, and pruritus; Neomycin inhibits protein synthesis in susceptible gram-positive and gram-negative bacteria; Clotrimazole inhibits ergosterol synthesis in fungal cell membranes.
3. Indications & Uses
- Infected eczema (bacterial and/or fungal superinfection)
- Infected seborrheic dermatitis
- Infected contact dermatitis
- Intertrigo (Candidal or bacterial)
- Infected psoriasis (under specialist supervision)
4. Dosage & Administration
Adult Dosage: Apply a thin layer to the affected area 2 to 3 times daily. Duration should be limited to 1-2 weeks. Maximum weekly amount: Not more than 50g cream per week for adults.
Administration: 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 after application unless hands are the treated area. 5. Do not cover with airtight dressings (occlusion) unless specifically advised by a doctor, as it increases absorption and side effects. 6. Avoid contact with eyes, nose, mouth, and other mucous membranes.
5. Side Effects
Common side effects may include:
- Local burning or stinging sensation (usually transient)
- Itching (pruritus) at application site
- Dryness of skin
- Erythema (redness)
- Skin irritation
6. Drug Interactions
| Drug | Effect | Severity |
|---|---|---|
| Other Topical Corticosteroids | Additive risk of local and systemic side effects (atrophy, HPA suppression). | Major |
| Systemic Aminoglycosides (e.g., Gentamicin, Amikacin) | Increased risk of ototoxicity and nephrotoxicity if Neomycin is absorbed systemically. | Major |
| Loop Diuretics (e.g., Furosemide) | Potentiates the ototoxic risk of Neomycin. | Moderate |
| Other Topical Agents (e.g., Salicylic Acid, Retinoids) | May increase skin irritation and penetration of active ingredients. | Moderate |
| CYP3A4 Inhibitors (e.g., Ketoconazole, Itraconazole, Clarithromycin) | May increase systemic levels of Beclometasone by inhibiting its metabolism, increasing steroid side effects. | Moderate |
7. Patient Counselling
- DO use exactly as prescribed by your doctor.
- DO wash and dry the area before application.
- DO use a thin layer; more cream does not mean better effect.
- DO wash your hands after applying, unless treating hands.
- DON'T use on the face, groin, or armpits unless directed by your doctor.
- DON'T cover the area with tight bandages or plastic wraps unless told to do so.
- DON'T use for longer than the prescribed duration (usually 1-2 weeks).
- DON'T share this medicine with others, even if they have similar symptoms.
8. Toxicology & Storage
Overdose: Topical overdose manifests as severe local steroid side effects: pronounced skin atrophy, striae, telangiectasia, HPA axis suppression (symptoms: weight gain, moon face, hypertension, hyperglycemia), and potential for Neomycin-induced ototoxicity (tinnitus, hearing loss) or nephrotoxicity if applied excessively over large areas or under occlusion.
Storage: Store below 25°C. Keep the tube tightly closed. Protect from light and moisture. Do not freeze. Keep out of reach and sight of children. Do not use after the expiry date printed on the pack.