Q: 54 year old male with long standing diabetes travelling from Thailand is admitted to ICU with sepsis, osteomylitis (diabetic foot) and Diabetic-Keto-Acidosis (DKA). Review of his home medications include fusidic acid. 'Charge nurse' ask your advice on possible contact isolation.  Fusidic acid is a  (select one)

A) Steroid antibiotic
B) Adjuvant treatment in Urinary Tract Infections (UTIs)
C) Treatment for gastroesophageal reflux (GERD) disease
D) First line of local cream in burn  patients
E) Decreases pulmonary pressure


Answer: A

 Fusidic acid is a steroid antibiotic which is not approved in USA for use. It is developed sometimes in 1960s and is available worldwide. It is available in injections, topical (cream), eye-drops and oral forms. As resistance to various antibiotics are on rise, there is a renewed interest in its use recently. It is effective primarily on gram-positive bacteria such as Staphylococcus, Streptococcus, and Corynebacterium species. It is bacteriostatic, and so mostly used as an adjunctive treatment. It is effective for use with other antibiotics in chronic osteomyelitis secondary to MRSA; like rifampin and flucloxacillin.



References:

1. Falagas ME, Grammatikos AP, Michalopoulos A. Potential of old-generation antibiotics to address current need for new antibiotics. Expert Rev Anti Infect Ther. 2008; 6(5):593-600 

2. "Fusidic acid in skin and soft tissue infections". International Journal of Antimicrobial Agents. 12 Suppl 2: S59–66. 

3. Howden BP, Grayson ML (2006). "Dumb and dumber—the potential waste of a useful antistaphylococcal agent: emerging fusidic acid resistance in Staphylococcus aureus". Clin Infect Dis. 42 (3): 394–400