Metos F

Uses

Fusidic Acid is used for the topical treatment of superficial bacterial infections of the eye and its adnexa. These may include - bacterial conjunctivitis, blepharoconjunctivitis, blepharitis, sty and keratitis. It may also be used for the management of corneal and conjunctival abrasions and foreign body injuries.

Mometasone furoate is a corticosteroid used to treat asthma, allergic rhinitis, nasal congestion, nasal polyps, dermatitis, and pruritus.

There are 3 formulations of mometasone furoate with various indications. The inhaler is indicated for prophylaxis of asthma in patients ≥4 years. The nasal spray is indicated for treating nasal symptoms of allergic rhinitis in patients ≥2 years, treating symptoms of nasal congestion from seasonal allergic rhinitis in patients ≥2 years, treating nasal polyps in patients ≥18 years, and prophylaxis of seasonal allergic rhinitis in patients ≥12 years. The ointment is indicated for symptomatic treatment of dermatitis and pruritis in patients ≥2 years.

Metos F is also used to associated treatment for these conditions: Bacterial Conjunctivitis, Eye and eyelid infections, Fungal skin infection, Skin Infections caused by Corynebacterium minutissimum infection, Skin Infections caused by Staphylococcus Aureus, Skin Infections caused by Streptococcus Infection, Skin Infections, Bacterial, Stye, Cutaneous dermatophyte infection, Eczematous rash, Mild Atopic dermatitis, Mild Dermatitis caused by Staphylococcus aureusis, Moderate Atopic dermatitis, Moderate Dermatitis caused by Staphylococcus aureusis, Ocular bacterial infections, Susceptible Bacterial InfectionsAllergic Rhinitis (AR), Asthma, Dermatitis, Dermatitis, Eczematous caused by superficial Fungal skin infection, Moderate to Severe Plaque Psoriasis, Polyps, Nasal, Pruritus, Psoriasis, Psoriasis, Moderate to Severe, Seasonal Allergies, Skin Diseases, Eczematous, Skin Infections

How Metos F works

Fusidic acid works by interfering with bacterial protein synthesis, specifically by preventing the translocation of the elongation factor G (EF-G) from the ribosome. It also can inhibit chloramphenicol acetyltransferase enzymes.

In asthma, mometasone is believed to inhibit mast cells, eosinophils, basophils, and lymphocytes. There is also evidence of inhibition of histamine, leukotrienes, and cytokines.

Corticosteroids diffuse across cell membranes into the cytosol of cells where they bind to glucocorticoid receptors to produce their activity. Mometasone furoate has a particularly high receptor affinity compare to other corticosteroids, 22 times higher than that of dexamethasone. Mometasone furoate binding to a glucocorticoid receptor causes conformational changes in the receptor, separation from chaperones, and the receptor moves to the nucleus. Once at the nucleus, receptors dimerize and bind to a DNA sequence known as the glucocorticoid response element which either increases expression of anti-inflammatory molecules or inhibits expression of pro-inflammatory molecules (such as interleukins 4 and 5). Mometasone furoate also reduces inflammation by blocking transcription factors such as activator-protein-1 and nuclear factor kappa B (NF-kappaB).

Dosage

Metos F dosage

Adults and children (≥ 2 years): Instill one drop in the affected eye(s) twice daily for 7 days. Treatment should be continued for at least 48 hours after the eye returns to normal.

Side Effects

Fusidic acid is generally associated with very few adverse effects. The most frequently reported treatment-related side-effect is slight stinging or irritation.

Toxicity

Overdose with a mometasone furoate inhaler may occur with chronic overuse. Symptoms of chronic overuse may present as hypercorticism and adrenal suppression, and patients may not require any more treatment than monitoring.

In animal studies of pregnancy, some fetal toxic effects were seen at or above the maximum recommended human dose, though rodents are more sensitive to these effects than humans. The benefits and risks of use should be considered in pregnant patients

It is unknown if mometasone furoate is excreted in breast milk but other corticosteroids are and therefore caution should be exercised when administering to nursing mothers.

Safety and effectiveness in pediatric populations has been established through clinical trials, though there may be a reduction in expected growth of about 1cm per year depending on the dose and duration of treatment. Pediatric patients should be titrated to the lowest effective dose for mometasone furoate inhalers.

A trial of geriatric patients showed no difference in safety or efficacy compared to younger patients, however patients of an even greater age may still be more sensitive to mometasone furoate.

The use of a mometasone furoate inhaler in moderate or severe hepatic impairment rarely leads to detectable plasma concentrations though caution may be prudent with increasing degrees of severity.

The effects of mometasone furoate in renal impairment, and across gender and race have not been studied.

Precaution

• For ophthalmic use only
• To avoid possible contamination of the drops, do not touch the tube nozzle or to any surface
• Do not wear contact lenses during the treatment
• If more than one topical eye drug is being used, the drugs should be administered at least five (5) minutes interval between applications

Interaction

Synergistic action with antistaphylococcal penicillin. Antagonism with ciprofloxacin.

Volume of Distribution

Steady state volume of distribution of 152L.

Elimination Route

Sodium fusidic acid tablets have a 91% oral bioavailability. Absorption of the film-coated tablets is complete when compared to a solution, however oral absorption is variable. Oral fusidic acid hemihydrate (suspension) achieved a 22.5% bioavailability in pediatric patients following a 20 milligram/kilogram dose.

Half Life

Approximately 5 to 6 hours in adults.

The terminal half life of an inhaled dose is approximately 5 hours though it has been reported as 5.8 hours by other sources.

Clearance

The clearance rate of mometasone furoate is not readily available, though it may be close to 90L/h.

Elimination Route

For an inhaled dose, approximately 74% is excreted in the feces and 8% is excreted in the urine.

Pregnancy & Breastfeeding use

Use in pregnancy: There are no adequate and well-controlled studies in pregnant women. Fusidic acid should be used during pregnancy unless the potential benefit justifies the potential risk to the fetus.

Use in lactation: It is not clear if enough medication from the eye drop would pass into breast milk. Caution should be exercised while giving this eye drops to a nursing mother

Contraindication

Fusidic acid viscous eye drops is contraindicated in patients who are hypersensitive to any component of Fusidic Acid (Eye Drops).

Special Warning

Use in children: Safety & effectiveness in children below the age of 2 years have not been established.

Storage Condition

Store between 2-25°C. Discard 1 mth after opening.

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