Miconazole

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The Pharmaceutical Journal
Vol 279 No 7464 p156
11 August 2007

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Letters

• Retention fees (10)
• Dispensing
• Community pharmacy
• Miconazole

Letters to the Editor

Miconazole

Reply from Jerry Cottrell (clinical affairs director at McNeil Ltd)

Inappropriate wording

From Mr L. Kumwenda, MRPharmS

Daktarin (miconazole) 2 per cent cream (P category) lists the following indication: “For fungal and associated bacterial infections of the skin and nails.”

I know bacterial infections of the skin need to be referred to the GP for a course of oral antibiotics or topical antibiotics, therefore the wording on topical miconazole may lead to inappropriate use. It is the same with nail infections — these should be treated with over-the-counter amorolfine or referred to the GP for a course or oral antifungals (terbinafine) or paints to be applied to the nail.

Luso Kumwenda
Swansea, West Glamorgan

JERRY COTTRELL, clinical affairs director at McNeil Ltd, responds:

The licensed indication for Daktarin cream (P category) since it was first licensed in 1974 reads “for the treatment of mycotic infections of the skin and nails and superinfections due to gram-positive bacteria”.

Miconazole has activity against many gram-positive bacteria found on the skin that can complicate primary fungal infections, such as tinea pedis. These mixed infections will usually, therefore, respond well to Daktarin cream. Treatment of primary bacterial skin infections is not an indication for Daktarin cream and referral to the GP is appropriate.

Daktarin cream is also indicated for fungal nail infections. Oral antifungal treatments are widely and appropriately prescribed for this indication. However oral treatments are not suitable in every case and antifungal creams such as Daktarin are used by podiatrists for some nail infections, particularly in conjunction with physical nail treatments, such as thinning or drilling.

Products have been licensed for mild fungal nail infections in the OTC market, but we do not promote this indication.

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