Fucidin

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Fucidin on Prescriptsy

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Fucidin is a topical antibiotic medicine used to treat skin infections caused by bacteria, most commonly Staphylococcus aureus.

It is available as Fucidin cream (containing fusidic acid 2%) and Fucidin ointment (containing sodium fusidate 2%), both manufactured by LEO Pharma.

Fucidin is a prescription-only medicine (POM) in the United Kingdom and is one of the most frequently prescribed topical antibiotics in UK general practice.

This page provides a comprehensive overview of Fucidin, including how it works, what it treats, how to use it, potential side effects, safety warnings, and how to obtain a prescription in the UK.

Important safety information about Fucidin

• Fucidin is a prescription-only medicine (POM) and should be used only under medical supervision.
• Apply a thin layer to the affected area two to three times daily for up to 7 days.
• Do not use Fucidin for longer than 10 days, as this promotes antibiotic resistance.
• Do not use leftover Fucidin to self-treat new infections without consulting a healthcare professional.
• Wash your hands before and after each application unless treating the hands themselves.

Understanding bacterial skin infections

Bacterial skin infections are extremely common in the United Kingdom, accounting for a significant proportion of GP consultations and antibiotic prescriptions in primary care.

The skin normally harbours a diverse community of microorganisms, but when the skin barrier is broken by cuts, scratches, insect bites, eczema, or surgical wounds, pathogenic bacteria can enter and multiply, causing localised infection.

The most common causative organism is Staphylococcus aureus, a Gram-positive bacterium that colonises the nose and skin of approximately 30% of the UK population without causing harm.

When it breaches the skin barrier, however, it can cause conditions ranging from minor folliculitis to extensive cellulitis.

Impetigo is a highly contagious superficial bacterial skin infection that primarily affects children. It presents as honey-coloured crusted lesions, typically around the nose and mouth.

Infected eczema occurs when bacteria colonise and infect already inflamed skin in patients with atopic eczema, causing increased redness, pain, weeping, and crusting.

Wound infections develop when bacteria contaminate surgical incisions, traumatic wounds, or chronic ulcers.

Folliculitis is infection of the hair follicles, presenting as small pustules or red bumps around hair-bearing areas.

How Fucidin works: mechanism of action

Fusidic acid is a steroidal antibiotic that works through a unique mechanism of action.

It inhibits bacterial protein synthesis by binding to elongation factor G (EF-G) on the bacterial ribosome.

EF-G is essential for the translocation step of protein synthesis, where the ribosome moves along the messenger RNA to read the next codon.

By blocking this step, fusidic acid prevents the bacterium from producing the proteins it needs to survive, grow, and divide.

The bacterium is unable to maintain its structure and function, leading to cell death (bactericidal activity at higher concentrations) or growth inhibition (bacteriostatic activity at lower concentrations).

This mechanism is distinct from all other major antibiotic classes, including penicillins, cephalosporins, macrolides, tetracyclines, and aminoglycosides.

This means that bacteria resistant to these other antibiotics may still be susceptible to fusidic acid, making it a valuable option for treating staphylococcal infections, including some strains of meticillin-resistant Staphylococcus aureus (MRSA).

When applied topically, fusidic acid penetrates both intact and damaged skin effectively, achieving therapeutic concentrations in the epidermis and dermis.

This good tissue penetration, combined with its potent anti-staphylococcal activity, makes it particularly well suited for treating superficial bacterial skin infections.

Clinical evidence and UK prescribing guidance

Fusidic acid has been used in clinical practice for over 50 years and has an extensive evidence base supporting its efficacy in treating staphylococcal skin infections.

Randomised controlled trials have demonstrated that topical fusidic acid is as effective as oral antibiotics for localised impetigo, with the advantage of avoiding systemic side effects.

NICE Clinical Knowledge Summaries recommend topical fusidic acid as a first-line treatment for localised non-bullous impetigo when the area of affected skin is small.

For more extensive impetigo or bullous impetigo, oral antibiotics such as flucloxacillin or clarithromycin are preferred.

The British Association of Dermatologists advises that topical antibiotics, including fusidic acid, should be used for short courses only to minimise the development of resistance.

The British National Formulary (BNF) lists fusidic acid as a topical antibacterial for use in primary and secondary skin infections caused by susceptible organisms.

It notes that topical fusidic acid should be reserved for short courses (usually 7 days) and should not be used as a long-term maintenance treatment.

The BNF also lists Fucidin H (fusidic acid 2% with hydrocortisone acetate 1%) for use when infection and inflammation coexist, as in infected eczema.

Antimicrobial resistance considerations

Antimicrobial resistance is one of the greatest public health challenges facing the UK and the world.

The UK government's five-year national action plan on antimicrobial resistance emphasises the importance of responsible antibiotic prescribing and use.

Fusidic acid resistance among Staphylococcus aureus isolates has been increasing in the UK, and this trend is directly linked to overuse and prolonged courses of topical fusidic acid.

Resistance to fusidic acid develops relatively easily through chromosomal mutations in the fusA gene encoding EF-G, or through acquisition of plasmid-borne resistance genes.

The risk of resistance is highest when fusidic acid is used as monotherapy for prolonged periods or when it is used repeatedly for recurrent infections.

For this reason, current UK guidelines strongly recommend limiting topical fusidic acid courses to 7 days (maximum 10 days), avoiding repeated courses within short timeframes, and not using fusidic acid for conditions where it is not indicated (such as viral or fungal infections).

Healthcare professionals in the UK are encouraged to take skin swabs for culture and sensitivity testing before prescribing topical antibiotics, particularly when infection does not respond to initial treatment or when MRSA is suspected.

If fusidic acid-resistant staphylococci are identified, alternative agents such as mupirocin or retapamulin may be considered.

Fucidin cream versus Fucidin ointment

Fucidin cream contains fusidic acid 2% in a water-based cream formulation. It spreads easily, is non-greasy, and is generally preferred for use on moist, weeping, or exudative lesions.

The cream base contains excipients including butylhydroxyanisole, cetyl alcohol, and sorbic acid, which may occasionally cause contact sensitivity in susceptible individuals.

Fucidin ointment contains sodium fusidate 2% in a greasy, anhydrous base containing lanolin (wool fat).

It is better suited for dry, crusted, or scaly skin infections, where the occlusive ointment base helps soften crusts and enhances drug penetration.

The ointment may be preferred in young children, as it is less likely to sting on application.

However, patients with known lanolin allergy should use the cream formulation instead.

Both formulations deliver the same concentration of active drug and are clinically equivalent in efficacy. The choice between cream and ointment is determined by the nature of the skin lesion, patient preference, and any known excipient sensitivities.

Dosage and administration

Apply Fucidin cream or ointment thinly to the affected area two to three times daily. Gently clean and dry the skin before each application.

If the area is covered with a dressing, application twice daily is usually sufficient, as the occlusive dressing increases local drug concentration.

The usual duration of treatment is 7 days. Do not exceed 10 days of treatment without clinical reassessment.

Wash your hands before and after applying Fucidin, unless the hands are the area being treated.

Avoid contact with the eyes, the inside of the nose, and mucous membranes. If the cream or ointment accidentally gets into the eyes, rinse thoroughly with clean water.

There is no need for dose adjustment in children, elderly patients, or patients with renal or hepatic impairment, as systemic absorption from topical application is minimal.

Fucidin may be used under occlusive dressings when directed by a healthcare professional, for example in the management of localised wound infections.

Side effects of Fucidin

Common side effects

The most frequently reported side effects are localised reactions at the application site, including mild stinging, burning, irritation, and redness.

These occur in up to 1 in 10 users and are usually transient, settling within a few minutes of application.

They are more common with the cream formulation than the ointment.

Uncommon and rare side effects

Uncommon reactions (up to 1 in 100 users) include localised eczema or dermatitis at the site of application, skin dryness, and mild rash.

Rare reactions (up to 1 in 1,000 users) include allergic contact dermatitis, urticaria, angioedema, and generalised hypersensitivity.

Very rarely, conjunctivitis may occur if the product contacts the eyes, and blistering at the application site has been reported.

When to seek medical advice

Discontinue use and seek medical attention if you develop signs of an allergic reaction, including widespread rash, swelling of the face, lips, tongue, or throat, or difficulty breathing.

Contact your GP or call NHS 111 if the infection worsens during treatment, if new symptoms develop (such as spreading redness, increasing pain, or fever), or if the infection has not improved after 7 days.

Call 999 if you experience a severe allergic reaction with breathing difficulty or collapse.

Report any suspected adverse reactions to the MHRA via the Yellow Card scheme at yellowcard.mhra.gov.uk .

Warnings and precautions

Contraindications

Do not use Fucidin if you are allergic to fusidic acid, sodium fusidate, or any of the excipients listed in the patient information leaflet.

Be aware that Fucidin cream contains butylhydroxyanisole, cetyl alcohol, and sorbic acid, and Fucidin ointment contains lanolin, all of which can cause localised skin reactions in sensitive individuals.

Antibiotic stewardship

Do not use Fucidin to self-treat infections that have not been assessed by a healthcare professional.

Do not use leftover Fucidin from a previous prescription to treat a new skin problem, as the organism causing the infection may be different or may have developed resistance.

Always complete the prescribed course but do not extend treatment beyond the recommended duration.

Pregnancy and breastfeeding

Topical Fucidin can be used during pregnancy and breastfeeding when clinically indicated.

Systemic absorption from topical application is negligible, and there are no reported adverse effects on the foetus or infant.

However, if you are breastfeeding, avoid applying Fucidin to the breast area to prevent accidental ingestion by the infant.

How to get Fucidin in the UK

Fucidin is a prescription-only medicine in the United Kingdom. Your GP can prescribe it after assessing your skin infection.

If your GP suspects a bacterial infection, they may take a wound swab for culture and sensitivity before prescribing, particularly if the infection appears severe, does not respond to initial treatment, or if MRSA is a concern.

Authorised online prescribers registered with the General Pharmaceutical Council (GPhC) can also prescribe Fucidin following an appropriate clinical consultation that may include review of photographs of the affected skin.

The NHS prescription charge in England is currently 9.90 pounds per item; prescriptions are free in Scotland, Wales, and Northern Ireland.

Caring for infected skin at home

Alongside using Fucidin, good skin hygiene is essential for clearing infection and preventing spread.

Keep the affected area clean by washing gently with warm water and a mild soap or soap substitute.

Pat the skin dry with a clean towel and do not share towels, flannels, or bedding with other household members to reduce the risk of transmission.

Keep fingernails short and clean to minimise scratching and further bacterial spread.

Children with impetigo should stay away from nursery or school until 48 hours after starting antibiotic treatment or until lesions have crusted and healed.

If you have underlying eczema, continue using your regular emollients and follow your eczema management plan.

Apply emollients before Fucidin, leaving a gap of at least 15 to 30 minutes between products.

Avoid known eczema triggers such as fragranced products, biological washing powders, and overheating.

Maintaining good skin barrier function with regular emollient use is the most effective strategy for preventing secondary bacterial infection of eczematous skin.

Sources

• Fucidin Cream, Summary of Product Characteristics (EMC)
• Fucidin Ointment, Summary of Product Characteristics (EMC)
• Fusidic acid, British National Formulary (BNF)
• NICE CKS: Impetigo
• Impetigo, NHS
• MHRA Yellow Card Scheme