Fusidic Acid 2% Cream
SUMMARY OF PRODUCT CHARACTERISTICS
1 NAME OF THE MEDICINAL PRODUCT
Fusidic Acid 2% Cream
2 QUALITATIVE AND QUANTITATIVE COMPOSITION
2 % cream. Each gram contains 20 mg fusidic acid.
Excipient(s) with known effect: Contains Butylhydroxyanisole 0.04 mg/gram, Cetyl alcohol 111.00 mg/gram, and Potassium sorbate 2.70 mg/gram.
For the full list of excipients, see section 6.1.
3 PHARMACEUTICAL FORM
Cream
White, homogenous cream.
4 CLINICAL PARTICULARS
4.1 Therapeutic indications
Treatment of non-severe, superficial, non-extensive, primary and secondary skin infections caused by microorganisms that are sensitive to fusidic acid, especially of infections caused by Staphylococcus (see section 5.1).
Primary skin infections that may be expected to respond to treatment with fusidic acid applied topically include: impetigo contagiosa, superficial folliculitis, sycosis barbae, paronychia and erythrasma. Also such secondary skin infections as infected eczematoid dermatitis, infected contact dermatitis and infected cuts/abrasions.
Consideration should be given to official guidance on the appropriate use of antibacterial agents.
4.2 Posology and method of administration
Posology
Adults and children:
Uncovered lesions: apply gently three or four times daily. Covered lesions: less frequent applications may be adequate.
Method of administration:
Cutaneous use
4.3 Contraindications
Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
4.4 Special warnings and precautions for use
Bacterial resistance among staphylococcus aureus has been reported to occur with the use of topical fusidic acid. As with all antibiotics, extended or recurrent use may increase the risk of developing antibiotic resistance.
Fusidic acid should not be used in infections caused by non-susceptible organisms, in particular, Pseudomonas aeruginosa, see section 5.1.
Extended or recurrent use may increase the risk of developing contact sensitisation.
Extended treatment of very large surfaces should be avoided, in particular in infants since the possibility of systemic toxic effects (jaundice) cannot be excluded.
Fusidic Acid contains butylhydroxyanisole, cetyl alcohol and potassium sorbate which may cause local skin reactions (e.g. contact dermatitis). Butylhydroxyanisole may also cause irritation to the eyes and mucous membranes. Fusidic Acid should therefore be used with care when applied to the proximity of the eyes.
Interaction with other medicinal products and other forms of interaction
4.5
No interaction studies have been performed. Interactions with systemically administered medicinal products are considered minimal as the systemic absorption of topical Fusidic Acid is negligible.
4.6 Fertility, pregnancy and lactation
Fertility
There are no clinical studies with topical Fusidic Acid regarding fertility. No effects in women of childbearing potential are anticipated, since systemic exposure following topically applied fusidic acid/sodium fusidate is negligible.
Pregnancy
No effects during pregnancy are anticipated, since systemic exposure to topically applied fusidic acid/sodium fusidate is negligible. Topical Fusidic Acid can be used during pregnancy.
Breast-feeding
No effects on the breastfed new-born/infant are anticipated since the systemic exposure of topically applied
fusidic acid/sodium fusidate to the breast-feeding woman is negligible. Topical Fusidic Acid can be
used during breast-feeding but it is recommended to avoid applying topical Fusidic Acid on the breast.
4.7 Effects on ability to drive and use machines
Fusidic Acid has no or negligible influence on the ability to drive and use machines.
4.8 Undesirable effects
The estimation of the frequency of undesirable effects is based on a pooled analysis of data from clinical trials and from spontaneous reporting.
Based on pooled data from clinical studies including 4724 patients who received fusidic acid cream or fusidic acid ointment, the frequency of undesirable effects is 2.3%.
The most frequently reported adverse reactions during treatment are various skin reactions such as pruritis and rash, followed by application site conditions such as pain and irritation, which all occurred in less than 1% of patients.
Hypersensitivity and angioedema have been reported.
Undesirable effects are listed by MeDRA System Organ Class (SOC) and the individual undesirable effects are listed starting with the most frequently reported. Within each frequency grouping, adverse reactions are presented in order of decreasing seriousness.
Very common > 1/10 Common >1/100 and <1/10 Uncommon >1/1,000 and <1/100 Rare >1/10,000 and <1/1,000 Very rare <1/10,000
Side effects are classified according to organ system, and within each organ, grouped by frequency.
Immune system disorders
Rare
(>1/10,000 and <1/1,000) Hypersensitivity
Eye disorders
Rare
(>1/10,000 and <1/1,000) Conjunctivitis
Skin and subcutaneous tissue disorders
Uncommon:
(>1/1,000 and <1/100)
Pruritus
Dermatitis (incl. dermatitis contact, eczema) Rash*
Erythema *Various types of rash reactions such as erythematous, pustular, vesicular, maculo-papular and popular have been reported. Rash generalised has also occurred.
Rare
(>1/10,000 and <1/1,000)
Angioedema
Uritcaria
Blister
General disorders and administration site conditions
Uncommon (>1/1,000 and <1/100)
Application site pain (incl. skin burning sensation)
Application site irritation
Paediatric population
Frequency, type and severity of adverse reactions in children are expected to be the same as in adults.
Reporting of suspected adverse reactions
Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard.
4.9 Overdose
Unless hypersensitivity to fusidic acid or any of the excipients exists, accidental ingestion of Fusidic Acid is unlikely to cause any harm. The total quantity of fusidic acid (30 g Fusidic Acid cream contains 600 mg fusidic acid) will usually not exceed the approved total daily oral dose of fusidic acid containing products except in children aged less than 1 year and weighing < 10 kg. Although in this instance a child of this particular age group is unlikely to ingest a whole tube of Fusidic Acid cream. The concentration of the excipients is too low to constitute a safety risk.
Systemic effects may be caused by too frequent or too copious applications, in particular on extensive skin surfaces. However, no cases of overdose have been reported so far.
In view of the formulation, accidental ingestion is unlikely.
5 PHARMACOLOGICAL PROPERTIES
5.1 Pharmacodynamic properties
Pharmacotherapeutic group: other antibiotics for topical use, ATC code: D06AX01
Active mechanism:
Fusidic acid belongs to a unique group of antibiotics, the fusidanes, which act to inhibit bacterial protein synthesis by blocking the lengthening of factor G. This is to prevent it from associating with ribosomes and GTP, thus preventing energy supply to the synthesis process.
As it is the only type of drug available in this family of drugs, there have been no reports of cross resistance to fusidic acid.
Resistance mechanism(s):
Resistance for fusidic acid can vary geographically and information about local resistance patterns should be obtained through a local microbiology laboratory. In general, resistance occurs in 1-10 % of Staphylococcus aureus and 10-20 % of coagulase negative staphylococcus. Cross-resistance between Fusidic Acid and other antibiotics has not been reported.
Breakpoints:
The following MIC values are recommended to distinguish sensitive and nonsensitive germs: S < 1 pg/ml and R > 1 pg/ml. This breakpoint should be used for the systemic use of fusidic acid. In general, no breakpoints are established for the topical use of antibiotics. Eucast published the following breakpoints for Staphylococcus: sensitive < 1 mg/L and resistant > 1 mg/L.
Sensitivity:
The sensitivity of organisms to fusidic acid is based on the in vitro sensitivity and plasma concentrations that are achieved after systemic therapy. Local treatment causes higher peak concentrations as compared to plasma. However, it is not known how the kinetics of the cream after local application may change the effectiveness of the cream.
|
Commonly susceptible species |
Staphylococcus aureus and Corynebacterium minutissimum; Clostridium spp. and Neiseria spp. |
|
Inherently resistant |
Streptococcus pyogenes; most gram negative bacilli including Haemophilus |
5.2 Pharmacokinetic properties
In Vitro studies show that fusidic acid can penetrate intact human skin. The degree of penetration depends on factors such as the duration of exposure to fusidic acid and the condition of the skin. Fusidic acid is excreted mainly in the bile with little excreted in the urine.
5.3 Preclinical safety data
There are no preclinical data of relevance to the prescriber which are additional to that already included in other sections of the SPC.
6 PHARMACEUTICAL PARTICULARS
6.1 List of excipients
Butylhydroxyanisol (E 320)
Cetyl alcohol Glycerol (85%)
Liquid paraffin Potassium sorbate (E 202) Polysorbate 60 White soft paraffin Hydrochloric acid for pH adjustment Purified water
6.2 Incompatibilities
Not applicable.
Shelf life
6.3
Unopened tube: 2 years.
After opening of the tube: 4 weeks.
6.4 Special precautions for storage
Do not store above 25°C.
6.5 Nature and contents of container
Aluminium tube with HDPE screw cap. Pack sizes: 15 gram and 30 gram.
Not all pack sizes may be marketed.
6.6 Special precautions for disposal
Not applicable.
7 MARKETING AUTHORISATION HOLDER
Teva UK Limited,
Brampton Road Hampden Park Eastbourne East Sussex BN22 9AG United Kingdom
MARKETING AUTHORISATION NUMBER(S)
8
PL 00289/1849
9 DATE OF FIRST AUTHORISATION/RENEWAL OF THE AUTHORISATION
16/10/2014
10 DATE OF REVISION OF THE TEXT
16/10/2014