Fusidic Acid

Fusidic acid 2% cream is the first-choice topical antibiotic in NICE NG190 for localised secondary bacterial infection of eczema. It is applied three times a day for 5–7 days. NICE warns that extended or repeated use quickly breeds resistance. DermNet also lists it, alongside mupirocin, for clearing nasal Staphylococcus aureus carriage in recurrent infection. It works by blocking bacterial protein synthesis through elongation factor G (Harkins, BJD 2018). It has a narrow spectrum, mainly against staphylococci.

Fusidic Acid [treats] Infected Eczema Fusidic Acid [treats] Staphylococcus aureus NICE NG190 [regulates] Fusidic Acid

NICE limits. NG190 says a child with infected eczema who is not systemically unwell should not routinely get a topical or oral antibiotic. The evidence shows “limited benefit with antibiotics in addition to topical corticosteroids compared with topical corticosteroids alone”. If a topical antibiotic is used, fusidic acid is for “localised infections only”, for 5–7 days, and prescribers must take “previous use of topical antibiotics” into account. For Impetigo, NICE NG153 goes further and puts Hydrogen Peroxide Cream ahead of fusidic acid. Fusidic acid is used only if peroxide is unsuitable (for example near the eyes) or fails, for 5 days, with Mupirocin as the switch when fusidic acid resistance is suspected or confirmed.

NICE NG153 [regulates] Fusidic Acid Hydrogen Peroxide Cream [precedes] Fusidic Acid Fusidic Acid [precedes] Mupirocin

Resistance linked to topical overuse. Children with eczema carry fusidic-acid-resistant staph much more often than other children. In a UK/Irish case-control genome study, resistance was 24 percentage points more frequent in S. aureus from children with Atopic Dermatitis than in healthy nasal carriers (P = 0.009), about 2.5-fold (Harkins et al., BJD 2018). The resistance came mostly from repeated, independent fusA mutations, “indicative of prior exposure and adaptation to fusidic acid therapy”. The authors attribute this to widespread community use of fusidic acid, often combined with a steroid. Earlier audits found recent topical use was the only independent risk factor for resistant staph (adjusted OR 7.5) (unverified). Restricting topical fusidic acid in one dermatology unit lowered resistance rates (cited in search results; abstracts not saved) (unverified). Resistant strains matter beyond eczema, because fusidic acid is also a systemic option for MRSA.

Fusidic Acid [relates] MRSA Atopic Dermatitis [relates] Fusidic Acid

Combination steroid–antibiotic creams. Fusidic acid is often prescribed ready-mixed with a steroid: Fucidin H (with 1% Hydrocortisone) or Fucibet (with betamethasone, a potent steroid unsuitable for routine toddler use). The Fucidin H leaflet gives twice-daily use and a “usual treatment time” of “up to 2 weeks”. It says to stop and return to the doctor if there is no improvement after 7 days. It warns that steroid side effects “are more likely in babies and children” and that a nappy can act as an occlusive dressing. It also contains butylhydroxyanisole and cetyl alcohol, which can cause a contact rash. A Cochrane review found steroid–antibiotic combinations may give slightly more improvement than steroid alone (RR 1.10, low-quality evidence), but no clear benefit for infected eczema overall. NICE NG190 does not list combination products at all.

Fucidin H [part-of] Fusidic Acid Hydrocortisone [part-of] Fucidin H Fucidin H [treats] Infected Eczema Cochrane [relates] Fucidin H

Conflict: [NICE NG190, 2021-03] limits topical fusidic acid for infected eczema to 5–7 days, for localised infection only, and not routinely in a well child. [Fucidin H PIL, LEO Pharma, rev. 2026-05] gives a “usual treatment time” of “up to 2 weeks”. The longer combination-cream course is exactly the extended use NICE and Harkins (BJD 2018) link to resistance. Unresolved — add to open_questions.

For parents. Fusidic acid is a short-course rescue, not a maintenance cream. Overall evidence it improves eczema is weak (Cochrane 2019), and repeat tubes kept “for flare-ups” are the pattern linked to resistance. Infected-looking eczema that does not improve, or spreads, needs reassessment for Eczema Herpeticum rather than another tube (NICE NG190).

Fusidic Acid [relates] Eczema Herpeticum

What parents report (evidence: anecdotal). Parents mention antibiotic creams mainly as part of a growing pile of products. One family “at one point had 4 separate steroid creams in varying prescription strengths plus antibiotic cream for when it got infected” (r/Parenting). Repeated infections usually led to a push for dermatology referral rather than more topical antibiotic. See Parent Experiences.

Fusidic Acid [relates] Parent Experiences

Connections

• Infected Eczema — first-line topical antibiotic, source: NICE NG190
• Staphylococcus aureus — topical anti-staph agent; decolonisation, source: DermNet
• Impetigo — second-line topical after hydrogen peroxide, source: NICE NG153
• NICE NG153 — places it after hydrogen peroxide for impetigo, source: NICE 2020
• NICE NG190 — 5–7 day limit, localised infection only, source: NICE 2021
• Mupirocin — alternative if fusidic resistance, source: NICE NG153
• Hydrogen Peroxide Cream — preferred first-line antiseptic for impetigo, source: NICE NG153
• Fucidin H — fusidic acid + hydrocortisone combination, source: Fucidin H PIL
• Hydrocortisone — steroid partner in Fucidin H, source: Fucidin H PIL
• MRSA — resistance threatens fusidic acid as a systemic MRSA option, source: Heng 2013 (abstract)
• Atopic Dermatitis — resistant staph enriched in AD children, source: Harkins BJD 2018
• Cochrane — combination creams: small, low-quality benefit, source: George 2019
• Parent Experiences — parent reports (anecdotal), source: round-10 forum threads