Dermatological Products
11.1 Antiinfectives

11.2 Antiinflammatory Agents

11.3 Antiinfective with Antiinflammatory Agents

11.4 Antipruritic Agents

11.5 Keratolytics and Cleansing Agents

11.6 Soothing and Protective Agents

11.7 Antiseptics and Disinfectants

11.8 Medicated Surgical Dressings

11.9 Miscellaneous

11.1 Antiinfectives

11.1.1 Antibiotics

FUSIDIC ACID (Sodium Fusidate)

Dosage Form: Oinment 2%; Intertulle 2% (II)

 

Recommended Dose: Ointment; Apply to affected area 3-4 times daily for 7 days. Intertulle; Apply daily.

 

Indications: Staphylococcal skin infections; penicillin-resistant staphylococcal infections. Superficial, traumatic or surgical wounds, varicose ulcers, abscesses & burns.

 

Special Precautions: Avoid contact with eyes

FUSIDIC ACID + BETAMETHASONE VALERATE

Dosage Form: Cream 2% + 0.1% (15 g) (I* - Dermatologist)

 

Recommended Dose: Uncovered lesions: Apply 2 - 3 times a day. Covered lesions: Less frequent applications may be adequate.

 

Indications: Inflammatory dermatoses where bacterial infection is present or likely to occur eg, atopic eczema, discoid eczema, stasis eczema, seborrhoeic dermatitis, contact dermatitis, lichen simplex chronicus, psoriasis, discoid lupus erythematosus.

 

Contra-Indications: Viral disease of the skin, perioral dermatitis, acne rosacea, fungal skin infections and ulcerative conditions.

 

Special Precautions: Atrophic striae likely to occur on prolonged application (>4 weeks). Systemic absorption resulting in adrenal suppression may occur especially under occlusion with weekly doses of >30 g. Avoid prolonged use on flexures and intertriginous areas.

MUPIROCIN

Dosage Form: Ointment 2% (15 g); Cream 2% (15 g) (I* - Dermatologist)

 

Recommended Dose: Adults and children should be applied to affected area up to 3times daily, for up to 10 days. The area may be covered with a dressing or occluded if desired.

 

Indications: It is effective for skin infections, particularly those due to Gram-positive organisms but it is not indicated for pseudomonal infection.

 

Contra-Indications: Hypersensitivity to any component of this drug.

 

Special Precautions: When it’s used on the face, care should be taken to avoid the eyes, it’s also should be used with caution if there is evidence of moderate or severe renal impairment.

NEOMYCIN SULPHATE

Dosage Form: Cream [P] 0.5% (II)

 

Recommended Dose: Apply sparingly to affected area tds.

 

Indications: Treatment of infection susceptible to staphylococci and Gram negative.

 

Contra-Indications: Hypersensitivity to neomycin.

 

Special Precautions: Caution in extensive dermatological condition where rapid absorption is possible, because of the possibility of otoneuromuscular blockade.

11.1.2 Sulphonamides

SILVER SULPHADIAZINE

Dosage Form: Cream 1% (II)

 

Recommended Dose: Apply using sterile spatula or hand covered with a sterile glove, daily to a thickness of 3-5 mm.

 

Indications: prophylaxis and treatment of infection in burn wounds; as an adjunct to short-term treatment of infection in leg ulcers and pressure sores; as an adjunct to prophylaxis of infection in skin graft donor sites and extensive abrasions; for conservative management of finger-tip injuries

It is particularly effective against Gram negative organisms such as Pseudomonas aureginosa.

 

Contra-Indications: pregnancy and breast-feeding, sensitivity to sulphonamides; not recommended for neonates

 

Special Precautions: One jar to be reserved for one patient. Any remaining cream to be discarded after completion of treatment.

Plasma-sulfadiazine concentrations may approach therapeutic levels with side-effects and interactions as for sulphonamides if large areas of skin are treated. Owing to the association of sulphonamides with severe blood and skin disorders treatment should be stopped immediately if blood disorders or rashes develop—but leucopenia developing 2–3 days after starting treatment of burns patients is reported usually to be self-limiting and silver sulfadiazine need not usually be discontinued provided blood counts are monitored carefully to ensure return to normality within a few days. Argyria may also occur if large areas of skin are treated (or if application is prolonged

11.1.3 Antifungals

CLOTRIMAZOLE

Dosage Form: Cream 1% (II)

 

Recommended Dose: Apply thinly and rubbed in bd-tds.

 

Indications: Treatment of fungal skin infections.

MICONAZOLE

Dosage Form: Cream 2% (as nitrate) (II)

 

Recommended Dose: For skin infections: apply twice daily continuing for 10 days after lesions have healed. For nail infections: apply 1-2 times daily.

 

Indications: Treatment of dermatophytoses, superficial mycoses and cutaneous candidiasis.

 

Contra-Indications: Known hypersensitivity to miconazole.

 

Special Precautions: Should not be allowed to come into contact with the eyes.

NYSTATIN

Dosage Form: Cream 100,000 units/gram (II)

 

Recommended Dose: Apply liberally to affected areas bd-qid as required.

 

Indications: Treatment of cutaneous and mucocutaneous infections caused by candida albicans. Combined with corticosteroids & antibacterial agents for various dermatologic conditions.

 

Contra-Indications: Hypersensitive to nystatin.

SELENIUM SULPHIDE

Dosage Form: Shampoo 2.5% (I* - Dermatologist)

 

Criteria of use: Indicated for Tinea Versicolor

 

Recommended Dose: May be used as a lotion (diluted with water to reduce irritation) and left on for at least 30 minutes or overnight; it is applied 2–7 times over a fortnight and the course repeated if necessary

 

Indications: Pityriasis versicolor (Tinea versicolor)

 

Special Precautions: Should not be applied to inflamed or exudative areas, or to extensive areas of the skin. Avoid contact with the eyes.

SODIUM THIOSULPHATE

Dosage Form: Lotion [P] 20% (II)

 

Recommended Dose: Apply once or bd. Treatment must be continued for 6 weeks after an apparent cure to prevent relapse.

 

Indications: Treatment of pityriasis versicolor.

 

Special Precautions: Discontinue if irritation or sensitivity occurs.

TINEA LOTION

Dosage Form: Lotion [P] (II)

 

Recommended Dose: Apply to affected area once or bd.

 

Indications: Treatment of tinea infections.

 

TIOCONAZOLE

 

Dosag Dosage Form: Cream 1% (20 g) (II)

 

Recommended Dose: Gently massage into the affected & surrounding area once-bd.

 

Indications: Dermal infections due to susceptible fungi & bacteria.

 

Contra-Indications: Hypersensitivity to imidazole antifungal agents.

 

Special Precautions: Not for ophth use

 

11.1.4 Antiparasitics

 

BENZYL BENZOATE

Dosage Form: Emulsion 25% (120 ml) (II)

 

Recommended Dose: Adult: Apply 3 times at 12-hrly intervals over the whole body, wash-off 12 hr after the last application.

 

Indications: Scabies

 

Contraindications: Broken or irritated skin; neonates; pregnancy.

 

Special Precautions: Prevent drug from entering the eyes, elderly (drying effects).

 

GAMMA BENZENE HEXACHLORIDE (BENZENE HEXACHLORIDE)  

 

Dosage Form: Emulsion 0.3% (200 ml) (II)

 

Recommended Dose: For lice: Thoroughly moisten scalp with lotion and allowed to dry naturally. Hair washed after 24 hrs. Repeat treatment 8 days later. For scabies: Apply lotion over whole body omitting head and neck, wash off after 24 hrs. Repeat after 7 days if required.

 

Indications: For treatment of head lice and scabies.

 

Special Precautions: Avoid contact with eyes. Repeated application can cause dermatitis. Concurrent treatment of family and close contacts recommended. Topical application can be absorbed and cause CNS toxicity.

CROTAMITON

Dosage Form: Lotion 10% (1L) (I)

 

Recommended Dose: Apply to entire body surface below the neck, after bathing and drying. Application should be repeated once daily preferably in the evening, for 5 days in succession. No baths until 2-3 days after completion of the treatment.

 

Indications:  Pruritus (including pruritus after scabies

 

Contra-Indications: Acute exudative dermatoses

 

Special Precautions: Should not be allowed to come in contact with the eyes. Not to be applied to acutely inflamed weeping skin conditions.

MALATHION

Dosage Form: Lotion 0.5%

 

Recommended Dose: Headlice, rub 0.5% preparation into dry hair and scalp, allow to dry naturally, remove by washing after 12. Crablice, apply 0.5% aqueous preparation over whole body, allow to dry naturally, wash off after 12 hours or overnight. Scabies, apply 0.5% preparation over whole body, and wash off after 24 hours; if hands are washed with soap within 24 hours, they should be retreated

 

Indications:  Head lice, Crab lice, Scabies

 

Special Precautions:  Avoid contact with eyes; do not use on broken or secondarily infected skin; do not use lotion more than once a week for 3 consecutive weeks; children under 6 months, medical supervision required; alcoholic lotions not recommended for head lice in severe eczema, asthma or in small children, or for scabies or crab lice.

PERMETHRIN

Dosage Form: Lotion 5% (II)

 

Recommended Dose: Scabies, apply 5% preparation over whole body and wash off after 8-12 hours; CHILD, apply over whole body including face, neck, scalp and ears; if hands washed with soap within 8 hours of application, they should be treated again with cream; repeat application after 7 days.

Crab lice, ADULT over 18 years, apply 5% cream over whole body, allow to dry naturally and wash off after 12 hours or after leaving on overnight; repeat application after 7 days.

 

Indications: Effective for scabies and crab lice. Permethrin is active against head lice but the formulation and licensed methods of application of the currents products make them unsuitable for the treatment of head lice.

 

Contra-Indications: Hypersensitivity to permethrin/chrysanthemums.

 

Special Precautions: Avoid contact with eyes; do not use on broken or secondarily infected skin; children under 6 months, medical supervision required for cream rinse (head lice); children aged 2 months-2 years, medical supervision required for dermal cream (scabies).

11.1.5 Antiviral

ACYCLOVIR

Dosage Form: Cream 5% (I)

 

Recommended Dose: Apply to lesions every 4 hours (5 times daily) for 5–10 days, starting at first sign of attack

 

Indications: Treatment of herpes simplex.

 

Contra-Indications: Hypersensitive to acyclovir.

11.1.6 Miscellaneous Local Antiinfectives

BENZOIC ACID + SALICYLIC ACID (WHITFIELD’S)

 

Dosage Form: Ointments [P]  6% + 3% (II)

 

Recommended Dose: Apply bd or tds.

 

Indications: Treatment of fungus infections of the skin.

11.2 Antiinflammatory Agents

BETAMETHASONE VALERATE

Dosage Form: Cream 0.01% (II); Ointment 0.025%, 0.01%, (I* : Dermatologist)

 

Criteria of use: Restricted to A.P Dr. Mokhtar Nor)

 

Recommended Dose: Apply sparingly bd-tds in very thin palm and rub. Reduce strength and frequency as condition responds. If necessary cover area with a dry dressing.

 

Indications: severe inflammatory skin disorders such as eczemas unresponsive to less potent corticosteroids; psoriasis

 

Contra-Indications: Hypersensitivity, in untreated bacterial, fungal or viral skin lesions.

 

Special Precautions: Avoid prolonged use in infants and children, and on the face. Topical steroids should never be used as prophylactic measure. Sudden withdrawal of prolonged therapy can produce rebound exacerbation of condition.

CLOBETASOL PROPIONATE

Dosage Form: Cream 0.05%; Ointment 0.05% (I)

 

Recommended Dose: Apply once or bd changing to lower potency therapy as condition is controlled.

 

Indications: Psoriasis, recalcitrant eczemas, lichen planus, discoid lupus erythematosus & other conditions which do not respond satisfactorily to less active steroids.

 

Contra-Indications: Rosaceae, acne vulgaris, perioral dermatitis, primary cutaneous viral infection; bacterial, fungal infected skin lesions; perianal & genital pruritis; children < 1 yr.

 

Special Precautions: Infants & children; prolonged facial use may exhibit atrophic changes; avoid eye contact; pregnancy; long-term continuous therapy.

CLOBETASONE BUTYRATE

Dosage Form: Cream 0.05%; Ointment 0.05% (I* - Dermatologist)

 

Recommended Dose: Apply thinly 1 - 2 times daily for up to 4 weeks; max. 50 g of 0.05% preparation per week.

 

Indications: Short-term treatment only of severe resistant inflammatory skin disorders such as recalcitrant eczemas unresponsive to less potent corticosteroids; psoriasis.

 

Contra-Indications: Untreated bacterial, fungal, or viral skin lesions; ulcerative conditions; rosacea (acne rosacea), perioral dermatitis; not recommended for acne vulgaris.

 

Special Precautions: Infants and children, prolonged and continuous use; pregnancy. Discontinue if secondary infection develops.

HYDROCORTISONE ACETATE

Dosage Form: Cream 1% (as acetate) (II)

 

Recommended Dose: Apply sparingly bd-qid. Reduce strength and frequency as condition responds.

 

Indications: Treatment of mild inflammatory skin disorders such as eczemas.

 

Contra-Indications: In untreated bacterial, fungal or viral skin lesions.

 

Special Precautions: Avoid prolonged use in infants and children, and on the face.

11.3 Antiinfective with Antiinflammatory Agents

BETAMETHASONE DIPROPIONATE + SALICYLIC ACID

Dosage Form: Ointment 0.05% + 3%, (15 gm) (II)

 

Recommended Dose: Apply thinly 1–2 times daily; max. 60 g per week (1)

 

Indications: Subacute and chronic hyperkeratotic and dry dermatoses.

 

Contra-Indications: Viral infection of the skin, TB and acne rosacea

11.4 Antipruritic Agents

CALAMINE

Dosage Form: Lotion; Cream [P] (II)

 

Recommended Dose: Apply when needed.

 

Indications: For pruritis. Sunburn, ivy poisoning and other skin disorders.

CALAMINE LOTION + SULPHUR

Dosage Form: Lotion

 

Recommended Dose: Apply when needed.

 

Indications: For pruritis.

11.5 Keratolytics and Cleansing Agents

ACETIC ACID

Dosage form: Solution [P]  1%, 5%, 20% (II)

 

Indications: Use for daily dressing to infected burns and wounds or using as a cleansing agent for skin. Also used for fungal infection.

 

Contra-Indications: Hypersensitivity to acetic acid product.

 

Special Precautions: Persistent stinging or burning.

 

AQUA DERMIS

 

Dosage form: Liquid cleanser 250 ml, 750 ml (II)

 

Recommended Dose: Use as a soap substitute.

 

Indications: Mild non-irritant liqd cleanser w/ acidic pH of 5.8 for all skin conditions, eczema & dermatitis.

CALCIPOTRIOL

Dosage Form: Cream 50 mcg/g; Ointment 50 mcg/g (I* - Dermatologist)

 

Recommended Dose: For cream and ointment: apply twice daily, maximum 100 g weekly. Children: > 6 years old; twice daily, 6-12 years old; maximum 50 g wkly, > 12 years old; maximum 75 g wkly.

 

Indications: Plaque psoriasis.

 

Contra- Indications: Disorder of calcium metabolism.

 

Special Precautions: Pregnancy, avoid use on face and inadvertent transfer to other body areas, risk of hypercalcaemia if maximum recommended weekly dose exceeded.

CETRIMIDE

Dosage Form: Lotion [P] 2%, 20% (II)

 

Recommended Dose: For a 1% w/v solution for skin cleansing dilute 1:20 with water. As shampoo 1-3% used. For perioperative scrubbing skin cleansing and disinfectant 1% solution used. For cleansing in wounds and burns 0.1% solution used.

 

Indications: For skin disinfection, soap solution or shampoo substitute in acne, skin infections and seborrhoea of the scalp.

 

Special Precautions: Avoid contact with eyes and in body cavities.

COAL TAR IN AQUEOUS CREAM

Dosage Form: Cream [P] 5%, 10% (II)

 

Recommended Dose: Apply 1–3 times daily starting with low-strength preparations

 

Indications: psoriasis and occasionally chronic atopic eczema

 

Special Precautions: not for use in sore, acute, or pustular psoriasis or in presence of infection

 

PODOPHYLLUM COMPOUND PAINT

Dosage Form: Paint [P] 15% (II)

 

Recommended Dose: Applied daily.

 

Indication: Removal of warts.

 

Contra-Indications: Patient using steroid or with poor blood circulation and diabetic patient. It is not to be used on bleeding warts, moles, birthmarks or unusual warts with hair growing from them.

 

Special Precautions: Keep away from the eyes.

 

SALICYLIC ACID + LACTIC ACID (DUOFILM)

Dosage Form: Paint 16.7% + 16.7% (II)

 

Recommended Dose: Soak warts in hot water for 5 minutes. Dry thoroughly. Apply without touching surrounding areas and cover with plaster. Repeat once daily until warts are completely cleared.

 

Indications: Warts, corns and calluses.

 

Contra-Indications: Diabetes, impaired blood circulation, moles, birthmarks, unusual skin growths, face or ano-genital regions.

 

Special Precautions: Avoid contact with eyes, or mucosal membranes and application to normal skin.

SALICYLIC ACID + DITHRANOL IN AQUEOUS CREAM

Dosage Form: Cream [P] 1% + 2% (II)

 

Recommended Dose: Concentration higher than 1% may be applied for very short exposure periods of 20-30 minutes and then remove from the skin.

(For ointment preparation, it is intended for application to the scalp and is readily removed with warm water.)

 

Indications: Psoriasis.

 

Contraindications: Hypersensitivity to salicylic acid.

 

Special Precautions: Avoid- broken and inflamed skin & contact with eyes.

SALICYLIC ACID + SULPHUR IN EMULSIFYING OINTMENT

Dosage Form: Ointment [P] 1% + 1%, 1% + 2%, 2% +2% (II)

 

Recommended Dose: As above.

 

Indications: As above.

 

Special Precautions: As above.

SALICYLIC ACID IN AQUEOUS CREAM

Dosage Form: Cream 2%, 10% (II)

 

Recommended Dose: Applied to affected area.

 

Indications: Used in concentration of 0.5% to 10% for acne, 3% to 6% as a keratolytic and in concentration of 5% to 40% for warts and corn removal.

 

Contra-Indications: Hypersensitivity to salicylic acid and children under 2 years old.

 

Special Precautions: Salicylate toxicity may occur after prolong used over large areas. It is irritating and may cause dermatitis. Also avoid contact with eyes, face, genital and mucous membranes.

SALICYLIC ACID IN WHITE SOFT PARAFFIN

Dosage Form: Ointment [P] 1%, 10%, 15%, 20% (II)

 

Recommended Dose: Apply bd as a thin layer.

 

Indications: Treatment of eczema, psoriasis, seborrhoiec dermatitis, hyperkeratosis.

 

Special Precautions: Avoid broken or inflamed skin.

SILVER NITRATE

Dosage Form: Lotion [P] 0.5%, 1%, 10% (II)

 

Recommended Dose: Applied to affected area or lesion.

 

Indications: As wet dressing of 0.1- 0.5% is used in treatment of burns and 10% solution is used to treat impetigo vulgaris.

 

Contra-Indication: Hypersensitivity to any component of the preparation and do not apply concentration higher than 0.5% and 1% silver nitrate to wounds, cuts or broken skin.

 

Special Precautions: If redness or irritation occur, discontinue use. Silver nitrate tends to stain skin and utensils, handle carefully. With prolonged used, monitor methemoglobin level of septic patient.  

SULPHUR IN AQUEOUS CREAM

Dosage Form: Cream [P] 20% (II)

 

Recommended Dose: Applied topically once to three times daily for several days with decreasing application frequency over time.

 

Indications: Treatment of acne, dandruff, rosacea, scabies and seborrheic dermatitis.

 

Contra-Indication: Hypersensitivity to sulphur or sulfonamide and kidney disease.

 

Special Precaution: Application to irritated or abraded skin (discontinue use if signs of sensitization develop

11.6 Soothing and Protective Agents

AQUEOUS CREAM

Dosage Form: Cream [P] (II)

 

Recommended Dose: Apply as directed. Can be used as soap substitutes for hand washing and in the bath; the preparation is rubbed on the skin before rinsing off completely

 

Indications: For dry scaling disorders.

 

LACTACYD (Lactic Acid + Lactoserum)

 

Dosage Form: Liquid (1 gm + 0.93 gm)/100 ml (II)

 

Recommended Dose: For facial & body wash Use as a soap substitute. For scalp care Use as a shampoo. Baby bath 1 capful to a tub 1/3 filled w/ water.

 

Indications: For facial & body wash in acne, occupational & tropical dermatitis, prickly heat, pruritus, eczema & seborrhoea. In paed for diaper rash, prickly heat, cradle cap, daily infant hygiene.

METHYL SALICYLATE

Dosage Form: Liniment [P] (II)

 

Recommended Dose: Applied with gentle massage bd-tds.

 

Indications: For relief of pain, lumbago sciatica and rheumatic conditions.

 

Special Precautions: Avoid broken or inflamed skin.

ZINC OXIDE

Dosage Form: Cream (II)

 

Recommended Dose: Apply bd.

 

Indications: For soothing, antiseptic and protective application in eczema, acne vulgaris, prickly heat, diaper rash and other skin disorders. For nappy and urinary rash and eczematous conditions

11.7 Antiseptics and Disinfectants

ACETIC ACID

Dosage Form: Solution [P] 1%, 5%, 20% (II)

 

Indications: Use for daily dressing to infected burns and wounds or using as a cleansing agent for skin. Also used for fungal infection.

 

Contra-Indication: Hypersensitivity to acetic acid product.

 

Special Precautions: Persistent stinging or burning.

ACRIFLAVINE

Dosage Form: Lotion [P] 0.1% (1:1000) (II)

 

Recommended Dose: Apply sparingly to affected part as required.

 

Indications: Skin disinfection for treatment of minor wounds, burns and infected skin.

ALCOHOL

Dosage Form: Lotion [P] 0.1% (1:1000) (II)

 

Recommended Dose: Apply sparingly to affected part as required.

 

Indications: Skin disinfection for treatment of minor wounds, burns and infected skin.

 

ADAZONE + PERACETIC ACID (ADASPOR)

 

Dosage Form: Liquid (II)

 

Recommended Dose: Achieves high level disinfection with 5 minutes of contact time and is sporicidal after 10 minutes

 

Indications: Chemical germicide for use in either, automated endoscope reprocessors, or for manual reprocessing.

 

Contraindications: Data not available

 

Special Precautions: NA

 

BENZALKONIUM CHLORIDE

 

Dosage form: Solution 4.225 gm/L (II)

 

Indications: As an antiseptic/disinfectant

BENZOIC ACID

Dosage Form: Solution [P] 5%. (II)

 

Recommended Dose: Apply topically to the affected area 1 or 2 times daily.

 

Indications: Treatment of fungal infections of the skin.

                                                   

Special Precautions: Topical applications may produce mild irritation at the site.

CETRIMIDE

Dosage Form: Lotion [P] 2%, 20% (II)

 

Recommended Dose: For a 1% w/v solution for skin cleansing dilute 1:20 with water. As shampoo 1-3% used. For perioperative scrubbing skin cleansing and disinfectant 1% solution used. For cleansing in wounds and burns 0.1% solution used.

 

Indications: For skin disinfection, soap solution or shampoo substitute in acne, skin infections and seborrhoea of the scalp.

 

Special Precautions: Avoid contact with eyes and in body cavities.

CHLORHEXIDINE GLUCONATE

Dosage Form: Scrub 4% (800 ml - Surgi Foam), (5 L - Hibiscrub) (II)

 

Recommended Dose: To be used instead of soap for pre-operative hand and skin preparation and for general hand and skin disinfection

CHLORHEXIDINE GLUCONATE 5%

Dosage Form: Solution 5% (II)

 

Indications: For dressing (General antisepsis)

 

Recommended Dose: To be used diluted 1 in 10 in alcohol 70% for pre-operative skin operation, or 1 in 100 (0.05%) with water for general skin disinfection.

 

Special Precautions: Avoid prolonged skin contact w/ alcoholic soln. Avoid contact w/ eyes, brain, meninges, middle ear & body cavities. For external use only.

 

Chlorhexidine Gluconate (20% - Desmanol)

Dosage Form: Solution 20% (II)

 

Indications: Instrument disinfection

 

Special Precautions: Avoid contact with eyes

CHLORHEXIDINE GLUCONATE AQUEOUS

Dosage Form: Solution [P] 0.5% (1:200) (II)

 

Recommended Dose: To be used undiluted for skin disinfection in wounds, burns and obstetrics.

 

Special Precautions: Avoid prolonged skin contact w/ alcoholic soln. Avoid contact w/ eyes, brain, meninges, middle ear & body cavities. For external use only.

CHLORHEXIDINE GLUCONATE CREAM

Dosage Form: Cream [P] 1%, 1% (Gynae) (II)

 

Recommended Dose: Apply sparingly to affected area. To be used in obstetrics as vaginal lubricant and for application to the vulva & perineum during labour.

CHLORHEXIDINE GLUCONATE IN ALCOHOL (Hibisol)

Dosage Form: Solution 0.5% in 70% (II)

 

Indications: Disinfection of clean intact skin. Pre-op surgical hand disinfection, hand disinfection on the ward prior to aseptic procedures or after handling contaminated material & for disinfection of patient's skin prior to surgery or other invasive procedures.

 

Recommended Dose: Pre-op surgical hand disinfection Spread 5 mL thoroughly over both hands & forearms, rubbing vigorously. When dry apply a further 5 mL & repeat procedure. Antiseptic hand disinfection on the ward Spread 3 mL thoroughly over the hands & wrists rubbing vigorously until dry. Disinfection of patient's skin Prior to surgery, apply to a sterile swab & rub vigorously over the operation site for a min of 2 mins.

 

Special Precautions: Avoid contact w/ eyes, brain meninges, body cavities, middle ear. Not for inj. Avoid prolonged skin contact. Allow to dry before proceeding.

 

Chlorhexidine Gluconate in Ethanol

Dosage Form: Solution 0.5% in ethanol 70% [P] - (II)

 

Recommended Dose: To be used undiluted for hand and skin disinfection.

 

Chlorhexidine Gluconate in Spirit

Dosage Form: Solution 0.5% in spirit 70% [P] (II)

 

Recommended Dose: To be used undiluted for pre-operative skin preparation and instruments.

 

Indications and Special Precautions: As above.

 

FORMALDEHYDE AQUEOUS

Dosage Form: Liquid 10% (II)

 

Recommended Dose: For disinfectant: as spray with equal volume of methylated spirit. For vaporisation by heat, with 2 parts of water. Treatment of warts as 1.5% solution. As preservation for pathological specimens: 10% formalin solution.

 

Indications: As disinfectant, deodorant, treatment of warts, and preservation for pathological specimens.

 

Special Precautions: Irritant to normal skin. Can cause dermatitis, allergic reaction and possibly cancer.

 

FORMALDEHYDE IN NORMAL SALINE

 

Dosage Form: Lotion 10% (II)

 

Indications: As disinfectant

 

Special Precautions: Irritant to normal skin. Can cause dermatitis & allergic reaction

 

Gigasept® (Cocospropylene Diamineguanidine Diacetate + Phenoxypropanol + Benzalkonium Chloride)

Dosage Form: Solution  (14 gm + 35 gm + 2.5 gm) per 100 gm (II)

 

Indications: As Instrument disinfectant

 

Special Precautions: Irritant to normal skin.

HYDROGEN PEROXIDE

Dosage Form: Solution (20 volumes) - (II)

 

Indications: As disinfectant, for cleansing and deodorising wounds and ulcers.

 

Special Precautions: Bleaches fabric, solutions above 6% should be diluted before application to the skin.

POTASSIUM PERMANGANATE

Dosage Form: Solution [P] 1:1000, 1:10,000 (II)

 

Recommended Dose: For cleansing ulcers and abcesses. As wet dressing 1-3 times a day or as required.

 

Indications: Cleansing and deodorising suppurating eczematous reactions, acute dermatoses and wounds.

 

Special Precautions: Irritant to mucous membrane. Repeated use of dilute solution may cause corrosive burns.

POVIDONE IODINE

Dosage Form: Solution 10% (Equivalent to 1% iodine) (II); Cutaneous solution 10% (Equivalent to 1% iodine) (Sterile) (I* - ICL, OT)

 

Recommended Dose: Apply/paint the area 1-2 times a day and allow to dry. Cutaneous solution; Apply undiluted to skin prior to surgery, or apply as appropriate to injured area.

 

Indications: Skin disinfection also can be used for contaminated wound, infection of the mouth, herpes infection, candidiasis, vaginal trichomoniasis, acne vulgaris, other pyogenic or seborrhoiec infections of scalp or skin and preoperative skin preparation.

 

Contra-Indications: Non-toxic nodular colloid goitre.

 

Special Precautions: Avoid application to large areas of broken skin.

SODIUM HYPOCHLORITE

Dosage Form: Solution [P] (10% available chlorine) (II)

 

Recommended Dose: To be diluted before use.

 

Indications: As disinfectant of hard surfaces, food and dairy equipment surgical purposes and wounds.

 

Special Precautions: Solution unstable and should be freshly prepared. Dissolve blood clots topically and may cause bleeding. Irritating to skin unless rinsed off promptly.

WEAK IODINE SOLUTION BP [Iodine Tincture]

Dosage Form: Solution 1% (4 L) (II)

 

Recommended Dose: To be used undiluted.

 

Indications: Skin disinfection in minor skin wound and perioperative preparation.

11.8 Medicated Surgical Dressings

Chlorhexidine Acetate (Bactigras)

Dosage Form: Tulle 10 cm x 10 cm, 15 cm x 20 cm, 15 cm x 1 M (II)

 

Recommended Dose: Daily to twice wkly dressing or more often as required. Cleanse wound before dressing.

 

Indications: Topical treatment of wounds w/ infective risk, infected wounds in conjunction w/ systemic antibacterials, minor burns & scalds, lacerations, abrasions, donor & recipient graft sites, leg ulcers.

 

Special Precautions:  Avoid extensive use (>10% of body area). Avoid contact w/ eyes, middle ear, meninges, brain.

11.9 Miscellaneous

BENZOYL PEROXIDE

Dosage Form: Gel 2.5%, 5% (I)

 

Recommended Dose: Apply 1–2 times daily preferably after washing with soap and water, start treatment with lower-strength preparations.

 

Indications: Acne vulgaris.        

 

Special Precautions: Avoid contact with eyes, mouth or other mucous membranes. May bleach dyed clothing and fabrics, avoid excessive exposure to sunlight.

ELASE [Fibrinolysin + Desoxyribonuclease]

Dosage Form: Ointment (135 u + 120,000 Christensen units)/100 gm

 

Recommended Dose: Apply a thin layer over dry, clean wound & cover w/ petrolatum gauze or non-adhering dressing. Dressing to be changed bd-tds. Vaginitis & cervicitis 5 mL of oint deposited deep in the vag once nightly for 5 applications.

 

Indications: Enzymatic debridement of necrotic tissue in wound & liquefaction & dissolution of exudates of injured skin & mucous membrane.

 

Special Precautions: Hypersensitivity to bovine compound.

 

EMLA [Lidocaine + Prilocaine]

 

Dosage Form: Cream (25 mg + 25 mg/gm) (5 gm)

 

Recommended Dose: Apply thick layer w/under occlusive dressing. Adult Approx 1.5 g/10 cm2. Minor procedures eg needle insertion & surgical treatment of localised lesions Adult 2 g (approx 1/2 tube) for a min of 1 hr, max 5 hr. Childn Approx 1 g/10 cm2. Application time: approx 1 hr. Dermal procedures on larger areas eg split skin grafting Adult Approx 1.5-2 g/10 cm2 for a min of 2 hr, max 5 hr. Surgical treatment of localised lesions eg removal of genital warts (condylomata acuminata) & prior to inj of local anaesth Adult Approx 5-10 g for 5-10 mins. No occlusive dressing required. Commence procedure immediately thereafter. Mechanical cleansing/debridement of Leg ulcer Adult Approx 1-2 g/10 cm2 up to a total of 10 g. Cover w/ occulsive dressing. Application time: at least 30 mins. Up to 60 mins may improve the anaesth further. Cleansing should start w/o delay after removal of cream.

 

Indications: Topical analgesia for use during needle insertion, superficial surgical procedures; leg ulcers prior to cleaning & superficial surgical procedures eg removal of fibrin, pus & necroses; genital mucosa.

 

Contra-Indications: Congenital or idiopathic methaemoglobinaemia. Open wounds other than leg ulcers. Genital mucosa of childn.

 

Special Precautions: Atopic dermatitis, application in vicinity of the eyes.

HYDROXYETHYL CELLULOSE

Dosage Form: K - Y Jelly 82 gm (II)

 

Recommended Dose: Apply sufficient for lubricating purposes.

 

Indications: For lubricating purposes eg. catheterization.

 

POLYTAR (Tar + Cade Oil + Coal Tar + Arachis Oil)

 

Dosage Form: Liquid 1% (0.3% + 0.3% + 0.1% + 0.3%) (I)

 

Recommended Dose: Use as scalp cleanser 2 - 3 times weekly for at least 3 weeks.

 

Indications: Scalp disorders including psoriasis, seborrhea, eczema, pruritis and dandruff of scalp.

SOLCOSERYL

Dosage Form: Jelly 10% (20 g); eye gel 8.3 mg/g (5 g); dental paste 5 g (I)

 

Recommended Dose: Apply 3-5 times daily (start treatment with jelly until formation of granulation tissue, then continue with oinment until complete epithelization).

 

Indications: Burns, scald, skin ulcers, traumatic and ischemic wounds and trophic lesions due to severe disorders of blood circulation.

TRETINOIN

Dosage Form: Cream 0.05% (II)

 

Recommended Dose: Apply thinly to affected area once or twice daily. Avoid exposure to sunlight and UV lamps.

 

Indications: Acne vulgaris.

 

Contra-Indications: pregnancy; women of child-bearing age should take adequate contraceptive precautions. Tretinoin is contra-indicated in personal or familial history of cutaneous epithelioma.

 

Special Precautions: Keep away from the eyes, mouth, angles of the nose and from mucous membrane.

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1999 M. ZURAIDI & CO