Terra-Cortril

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Terra-Cortril on Prescriptsy

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Terra-Cortril is a topical combination ointment containing oxytetracycline 3% (a broad-spectrum tetracycline antibiotic) and hydrocortisone 1% (a mild corticosteroid).

It is prescribed for the treatment of inflammatory skin conditions complicated by bacterial infection, most commonly infected eczema (atopic dermatitis with secondary bacterial infection).

The oxytetracycline component treats the bacterial infection, while the hydrocortisone component reduces the inflammation, redness, and itching that characterise the underlying skin condition.

Terra-Cortril is a prescription-only medicine (POM) in the United Kingdom.

Bacterial superinfection of eczema is a common clinical problem.

The skin of patients with atopic eczema is frequently colonised by Staphylococcus aureus, with colonisation rates of 70% to 90% on lesional skin and 30% to 40% on non-lesional skin, compared with approximately 5% in people without eczema.

The impaired skin barrier, scratching, and immune dysregulation that characterise eczema create a favourable environment for bacterial colonisation and infection.

When eczema becomes infected, it worsens rapidly, with increased redness, weeping, crusting, pain, and spread to previously unaffected areas.

Prompt treatment of the infection alongside control of the underlying inflammation is essential to prevent deterioration and promote healing.

This page provides a comprehensive clinical guide to Terra-Cortril, covering how it works, dosage instructions, side effects, safety warnings, and how to obtain a prescription in the United Kingdom.

Important safety information about Terra-Cortril

Before reading further, please note these essential safety points.

• Do not use Terra-Cortril for more than 7 days without medical review, as prolonged topical antibiotic use promotes bacterial resistance.
• Do not apply Terra-Cortril to viral infections (cold sores, chickenpox, shingles), fungal infections (ringworm, athlete's foot), acne, or rosacea.
• If the infection worsens or spreads during treatment (increasing redness, fever, malaise), seek prompt medical attention, as oral antibiotics may be needed.
• Terra-Cortril may cause yellow staining of the skin and clothing.
• Avoid using Terra-Cortril during pregnancy unless the benefit clearly outweighs the risk, due to the tetracycline component.

Understanding infected eczema

Atopic eczema is a chronic inflammatory skin disease affecting approximately 16% to 20% of children and 5% to 10% of adults in the UK.

The condition results from a combination of genetic factors (including filaggrin gene mutations that impair the skin barrier), immune dysregulation (T-helper 2 dominant inflammation), and environmental triggers (allergens, irritants, microbes).

The defective skin barrier allows water loss and penetration of allergens, irritants, and microorganisms, driving a cycle of inflammation, itching, scratching, and further barrier damage.

Staphylococcus aureus plays a central role in the pathogenesis and exacerbation of atopic eczema. S.

aureus colonises the skin of most eczema patients and can cause clinical infection (impetiginisation) when it breaches the damaged epidermis.

Signs of secondary bacterial infection include increased redness and swelling, weeping or exudate (clear or yellowish fluid), golden or honey-coloured crusting (typical of impetigo), pustules, increased pain (rather than just itch), and rapid worsening of previously stable eczema.

Scratching increases the risk of introducing bacteria into the skin.

NICE guideline NG169 (atopic eczema in adults) and CG57 (atopic eczema in children) recommend that clinical signs of bacterial infection in eczema should be treated with a short course (7 days) of a topical antibiotic-corticosteroid combination for localised infection, or oral antibiotics (flucloxacillin first-line) for widespread or systemically unwell patients.

Terra-Cortril is one of the available topical antibiotic-corticosteroid combinations, alongside Fucidin H (fusidic acid with hydrocortisone).

How Terra-Cortril works

The oxytetracycline component of Terra-Cortril exerts its antibacterial effect by inhibiting bacterial protein synthesis. Oxytetracycline enters susceptible bacterial cells through outer membrane porins and energy-dependent transport systems.

Inside the cell, it binds reversibly to the 30S ribosomal subunit at the aminoacyl-tRNA acceptor site, preventing the binding of aminoacyl-tRNA to the mRNA-ribosome complex.

This blocks the addition of new amino acids to the growing peptide chain, inhibiting protein synthesis.

The effect is bacteriostatic (inhibiting growth rather than killing bacteria directly), though at the high concentrations achieved with topical application, a bactericidal effect may occur.

Oxytetracycline has broad-spectrum activity against many Gram-positive organisms (including S. aureus and streptococci) and Gram-negative organisms. However, resistance to tetracyclines has increased over time, particularly among staphylococci.

If the infection does not respond to Terra-Cortril within 7 days, a bacterial swab should be taken for culture and sensitivity testing to guide further antibiotic choice.

The hydrocortisone component is a mild corticosteroid (the mildest potency category in the BNF classification).

It binds to intracellular glucocorticoid receptors in the skin, suppressing the transcription of pro-inflammatory genes and reducing the production of cytokines, prostaglandins, and leukotrienes.

This leads to reduced inflammation (erythema, oedema), reduced itching (via suppression of inflammatory mediators that stimulate sensory nerve endings), and vasoconstriction (reducing redness).

The mild potency of hydrocortisone 1% means it has a lower risk of corticosteroid side effects compared with potent or very potent preparations, making it suitable for use on the face, flexures, and in children.

Terra-Cortril compared with other combination preparations

Several topical antibiotic-corticosteroid combinations are available in the UK for infected eczema.

The most commonly used are Terra-Cortril (oxytetracycline plus hydrocortisone), Fucidin H (fusidic acid 2% plus hydrocortisone 1%), and Trimovate (clobetasone butyrate 0.05% plus oxytetracycline 3% plus nystatin 100,000 units/g).

Each has different advantages and limitations.

Fucidin H is often preferred over Terra-Cortril for infected eczema because fusidic acid has better activity against S. aureus, including many strains with tetracycline resistance.

However, fusidic acid resistance is also increasing, particularly with overuse and prolonged courses.

NICE guidelines do not specify a preferred topical antibiotic-corticosteroid combination, but emphasise that courses should be limited to 7 days to minimise resistance development.

Trimovate adds nystatin (an antifungal) and uses a moderately potent corticosteroid (clobetasone butyrate), making it suitable when both bacterial and candidal infection are suspected, or when a stronger corticosteroid is needed.

However, the moderately potent steroid carries a greater risk of skin thinning than the mild hydrocortisone in Terra-Cortril.

For widespread infected eczema or systemically unwell patients (fever, malaise, lymphadenopathy), topical treatment alone is insufficient.

Oral antibiotics are required, with flucloxacillin 500 mg four times daily for 7 days as first-line treatment (or clarithromycin or erythromycin if penicillin-allergic), as recommended by NICE guidelines.

Antimicrobial resistance considerations

Antimicrobial resistance is a major public health concern in the UK and globally.

The overuse and prolonged use of topical antibiotics contributes to the development of resistant bacterial strains.

The UK Five Year Antimicrobial Resistance Strategy and NICE antimicrobial stewardship guidelines emphasise the importance of limiting antibiotic courses to the shortest effective duration, using antibiotics only when clinically indicated (not for colonisation without clinical infection), and avoiding prolonged or repeated courses of topical antibiotics.

For this reason, Terra-Cortril should be used for a maximum of 7 days per course, should not be used as a long-term maintenance treatment for eczema, and should not be used to prevent infection in uninfected eczema.

If recurrent infections occur, consider strategies to reduce S.

aureus colonisation (antiseptic bath additives such as potassium permanganate or emollient bath oils, nasal mupirocin for nasal carriers) and optimise baseline eczema management with emollients and appropriate anti-inflammatory treatments.

Dosage and administration

Apply a thin layer of Terra-Cortril ointment to the affected infected area two to four times daily for 7 days.

Use the fingertip unit method to measure the appropriate amount. Apply to clean, dry skin.

If using an emollient, apply the emollient first and wait 15 to 30 minutes before applying Terra-Cortril. Do not cover with airtight dressings unless directed by your prescriber.

Side effects of Terra-Cortril

Local effects

Burning, stinging, or irritation at the application site may occur and is usually mild and transient. Contact sensitisation to oxytetracycline is a recognised risk, particularly with repeated courses.

Yellow skin staining from oxytetracycline is temporary. Photosensitivity (increased sensitivity to sunlight) may occur on treated areas.

Corticosteroid effects

Hydrocortisone 1% is a mild corticosteroid with a low risk of skin thinning, telangiectasia, or striae when used for short courses (7 days).

These effects are more associated with potent or very potent corticosteroids and prolonged use. The risk is higher on thin-skinned areas such as the face, eyelids, and flexures.

Antibiotic-related effects

Prolonged use may lead to overgrowth of non-susceptible organisms, including Candida species. Bacterial resistance may develop if treatment is extended beyond the recommended duration or if repeated courses are used frequently.

When to seek medical advice

Seek medical advice if the infection worsens or does not improve after 7 days, if you develop a new rash or worsening itch (possible allergic reaction to the preparation), or if the redness spreads beyond the treated area (possible cellulitis requiring oral antibiotics).

Call 999 in an emergency. Report suspected adverse reactions to the MHRA at yellowcard.mhra.gov.uk .

Warnings and precautions

Contraindications

Do not use Terra-Cortril on viral skin infections (herpes simplex, chickenpox, shingles), fungal infections (ringworm, athlete's foot, candida), acne, rosacea, perioral dermatitis, or ulcerated wounds. Using a corticosteroid on these conditions can cause significant worsening.

Duration of treatment

Limit treatment to 7 days. Do not use Terra-Cortril as a long-term treatment or as a preventive measure for recurrent infections.

If frequent courses are needed, review the overall eczema management plan, including emollient use, avoidance of triggers, and escalation of anti-inflammatory treatment.

Face and flexures

Use on the face should be limited and only under prescriber direction.

The mild potency of hydrocortisone 1% makes Terra-Cortril more suitable for sensitive areas than preparations containing potent corticosteroids, but prolonged use on the face should still be avoided.

The flexures (groin, axillae) are also susceptible to corticosteroid side effects due to thin skin and natural occlusion.

Children

Terra-Cortril can be used in children when prescribed by a doctor, but the treatment area and duration should be minimised.

Children have a higher body surface area to weight ratio, increasing the risk of systemic absorption. Monitor for signs of skin thinning or infection worsening.

Pregnancy and breastfeeding

Systemic tetracyclines are avoided in pregnancy due to potential effects on foetal bone and tooth development.

Although topical absorption is low, Terra-Cortril should be used during pregnancy only if the prescriber considers the benefit outweighs the risk.

Alternative preparations not containing tetracyclines (such as Fucidin H) may be preferred. If used during breastfeeding, do not apply to the breast area.

How to get Terra-Cortril in the UK

Terra-Cortril is available on NHS prescription from your GP or an authorised online prescriber registered with the General Pharmaceutical Council (GPhC).

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

Your GP may also refer you to a dermatologist if your eczema is difficult to manage or frequently becomes infected.

Sources

• Terra-Cortril Ointment, Summary of Product Characteristics (EMC)
• Oxytetracycline, British National Formulary (BNF)
• Eczema, atopic, NICE CKS
• Atopic eczema, NHS
• NICE NG169: Atopic eczema in adults
• MHRA Yellow Card Scheme