Fusidic acid

{{Short description|Topical Antibiotic}} {{Use dmy dates|date=May 2024}} {{cs1 config|name-list-style=vanc|display-authors=6}} {{Infobox drug | Verifiedfields = changed | verifiedrevid = 476993164 | image = Fusidic acid structure.svg | image_class = skin-invert-image | width = | alt =

| pronounce = | tradename = Fucidin, Foban, others | Drugs.com = {{drugs.com|CONS|fusidic-acid-oral-injection}} | MedlinePlus = | DailyMedID =  | pregnancy_AU =  | pregnancy_AU_comment = | pregnancy_category = | routes_of_administration = Topical | class = | ATC_prefix = D06 | ATC_suffix = AX01 | ATC_supplemental = {{ATC|D09|AA02}} (dressing) {{ATC|J01|XC01}} {{ATC|S01|AA13}}

| legal_AU =  | legal_AU_comment = | legal_BR =  | legal_BR_comment = | legal_CA =  | legal_CA_comment = | legal_DE =  | legal_DE_comment = | legal_NZ = Prescription only | legal_UK = POM | legal_UK_comment =<ref name="NHS">{{cite web |author= |date=30 November 2021 |title=About fusidic acid |url=https://www.nhs.uk/medicines/fusidic-acid/about-fusidic-acid/ |website=NHS |location=London |access-date=7 May 2024}}</ref> | legal_US = OTC | legal_US_comment = /{{nbsp}}Not approved<ref>{{cite web | title=Fucidin- sodium fusidate ointment | website=DailyMed | date=6 November 2019 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=96b7b841-0954-85a2-e053-2995a90aafdf | access-date=5 May 2024}}</ref> | legal_EU = | legal_EU_comment = | legal_UN =  | legal_UN_comment = | legal_status = Rx-only

| CAS_number_Ref = {{cascite|correct|??}} | CAS_number = 6990-06-3 | CAS_supplemental = | PubChem = 3000226 | IUPHAR_ligand = | DrugBank_Ref = {{drugbankcite|correct|drugbank}} | DrugBank = DB02703 | ChemSpiderID_Ref = {{chemspidercite|correct|chemspider}} | ChemSpiderID = 2271900 | UNII_Ref = {{fdacite|correct|FDA}} | UNII = 59XE10C19C | UNII2 = J7P3696BCQ | KEGG_Ref = {{keggcite|changed|kegg}} | KEGG = D04281 | KEGG2 = D00213 | ChEBI_Ref = {{ebicite|correct|EBI}} | ChEBI = 29013 | ChEMBL_Ref = {{ebicite|correct|EBI}} | ChEMBL = 374975 | NIAID_ChemDB = | PDB_ligand = FUA | synonyms = Sodium fusidate

| IUPAC_name = 2-[(1''S'',2''S'',5''R'',6''S'',7''S'',10''S'',11''S'',13''S'',14''Z'',15''R'',17''R'')-13-(acetyloxy)-5,17-dihydroxy-2,6,10,11-tetramethyltetracyclo[8.7.0.0<sup>2,7</sup>.0<sup>11,15</sup>]heptadecan-14-ylidene]-6-methylhept-5-enoic acid | C=31 | H=48 | O=6 | SMILES = O=C(O)/C(=C3/[C@@H]2C[C@@H](O)[C@H]1[C@@]4(C)CC[C@@H](O)[C@@H](C)[C@@H]4CC[C@@]1([C@]2(C[C@@H]3OC(=O)C)C)C)CC\C=C(/C)C | StdInChI_Ref = {{stdinchicite|correct|chemspider}} | StdInChI = 1S/C31H48O6/c1-17(2)9-8-10-20(28(35)36)26-22-15-24(34)27-29(5)13-12-23(33)18(3)21(29)11-14-30(27,6)31(22,7)16-25(26)37-19(4)32/h9,18,21-25,27,33-34H,8,10-16H2,1-7H3,(H,35,36)/b26-20-/t18-,21-,22-,23+,24+,25-,27-,29-,30-,31-/m0/s1 | StdInChI_comment = | StdInChIKey_Ref = {{stdinchicite|correct|chemspider}} | StdInChIKey = IECPWNUMDGFDKC-MZJAQBGESA-N | density = | density_notes = | melting_point = | melting_high = | melting_notes = | boiling_point = | boiling_notes = | solubility = | sol_units = | specific_rotation = }}

'''Fusidic acid''', sold under the brand name '''Fucidin''' among others, is an antibiotic that is often used topically in creams or ointments and eyedrops but may also be given systemically as tablets or injections. {{As of|October 2008}}, the global problem of advancing antimicrobial resistance has led to a renewed interest in its use.<ref name="Falagas-2008">{{cite journal | vauthors = Falagas ME, Grammatikos AP, Michalopoulos A | title = Potential of old-generation antibiotics to address current need for new antibiotics | journal = Expert Review of Anti-Infective Therapy | volume = 6 | issue = 5 | pages = 593–600 | date = October 2008 | pmid = 18847400 | doi = 10.1586/14787210.6.5.593 | s2cid = 13158593 }}</ref>

==Medical uses== Fusidic acid is active ''in vitro'' against ''Staphylococcus aureus'',<ref name="Collignon-1999">{{cite journal | vauthors = Collignon P, Turnidge J | title = Fusidic acid in vitro activity | journal = International Journal of Antimicrobial Agents | volume = 12 | issue = Supplement 2 | pages = S45–S58 | date = August 1999 | pmid = 10528786 | doi = 10.1016/s0924-8579(98)00073-9 }}</ref> most coagulase-positive staphylococci, Beta-hemolytic streptococci, ''Corynebacterium'' species, and most clostridium species.{{medical citation needed|date=May 2024}} Fusidic acid has no known useful activity against enterococci or most Gram-negative bacteria (except Neisseria, Moraxella, ''Legionella pneumophila'', and ''Bacteroides fragilis'').{{medical citation needed|date=May 2024}} Fusidic acid is active ''in vitro'' and clinically against ''Mycobacterium leprae'' but has only marginal activity against ''Mycobacterium tuberculosis''.{{medical citation needed|date=May 2024}}

One use of fusidic acid is its activity against methicillin-resistant ''Staphylococcus aureus'' (MRSA).<ref name="Collignon-1999" /> Although many strains of MRSA remain sensitive to fusidic acid, there is a low genetic barrier to drug resistance (a single point mutation is all that is required). Fusidic acid should never be used on its own to treat serious MRSA infection and should be combined with another antimicrobial such as rifampicin when administering oral or topical dosing regimens approved in Europe, Canada, and elsewhere.<ref name="Howden2006"/> However, resistance selection is low when pathogens are challenged at high drug exposure.<ref>{{cite journal | vauthors = O'Neill AJ, Chopra I | title = Preclinical evaluation of novel antibacterial agents by microbiological and molecular techniques | journal = Expert Opinion on Investigational Drugs | volume = 13 | issue = 8 | pages = 1045–1063 | date = August 2004 | pmid = 15268641 | doi = 10.1517/13543784.13.8.1045 | s2cid = 24016698 }}</ref>

Topical fusidic acid is occasionally used as a treatment for acne vulgaris.<ref>{{cite journal | vauthors = Spelman D | title = Fusidic acid in skin and soft tissue infections | journal = International Journal of Antimicrobial Agents | volume = 12 | issue = Suppl 2 | pages = S59–S66 | date = August 1999 | pmid = 10528787 | doi = 10.1016/s0924-8579(98)00074-0 }}</ref> As a treatment for acne, fusidic acid is often partially effective at improving acne symptoms.<ref>{{cite web|url=http://scienceofacne.com/fusidic-acid-fucidin/|title=Fusidic Acid and Acne Vulgaris |publisher=ScienceOfAcne.com |date=11 September 2011 |access-date=14 August 2012}}</ref> However, research studies have indicated that fusidic acid is not as highly active against ''Cutibacterium acnes'' as many other antibiotics that are commonly used as acne treatments.<ref>{{cite journal | vauthors = Sommer S, Bojar R, Cunliffe WJ, Holland D, Holland KT, Naags H | title = Investigation of the mechanism of action of 2% fusidic acid lotion in the treatment of acne vulgaris | journal = Clinical and Experimental Dermatology | volume = 22 | issue = 5 | pages = 211–215 | date = September 1997 | pmid = 9536540 | doi = 10.1046/j.1365-2230.1997.2530670.x | doi-broken-date = 29 July 2025 }}</ref> Fusidic acid is also found in several additional topical skin and eye preparations (e.g., Fucibet), although its use for these purposes is controversial.<ref name="Howden2006">{{cite journal | vauthors = Howden BP, Grayson ML | title = Dumb and dumber--the potential waste of a useful antistaphylococcal agent: emerging fusidic acid resistance in Staphylococcus aureus | journal = Clinical Infectious Diseases | volume = 42 | issue = 3 | pages = 394–400 | date = February 2006 | pmid = 16392088 | doi = 10.1086/499365 | doi-access = free | title-link = doi }}</ref>

== Side effects ==

Fucidin tablets and suspension, whose active ingredient is sodium fusidate, occasionally cause liver damage, which can produce jaundice (yellowing of the skin and the whites of the eyes). This condition will almost always get better after the patient finishes taking Fucidin tablets or suspension. Other related side-effects include dark urine and lighter-than-usual feces. These, too, should normalize when the course of treatment is completed.<ref>{{cite web | url = http://www.betterhealth.vic.gov.au/bhcv2/bhcmed.nsf/pages/cscfucts/$File/cscfucts.pdf | title = Fucidin patient information leaflet | work = Government of Victoria, Australia | archive-url = https://web.archive.org/web/20110720113831/http://www.betterhealth.vic.gov.au/bhcv2/bhcmed.nsf/pages/cscfucts/$File/cscfucts.pdf | archive-date=20 July 2011 }}</ref>

==Pharmacology== Fusidic acid acts as a bacterial protein synthesis inhibitor by preventing the turnover of elongation factor G (EF-G) from the ribosome. Fusidic acid is effective primarily on Gram-positive bacteria such as ''Staphylococcus'', ''Streptococcus''<ref>{{cite journal | vauthors = Leclercq R, Bismuth R, Casin I, Cavallo JD, Croizé J, Felten A, Goldstein F, Monteil H, Quentin-Noury C, Reverdy M, Vergnaud M, Roiron R | title = In vitro activity of fusidic acid against streptococci isolated from skin and soft tissue infections | journal = The Journal of Antimicrobial Chemotherapy | volume = 45 | issue = 1 | pages = 27–29 | date = January 2000 | pmid = 10629009 | doi = 10.1093/jac/45.1.27 | doi-access = free | title-link = doi }}</ref> and ''Corynebacterium'' species.

Fusidic acid is a tetracyclic, naturally occurring steroid derived from the fungus ''Fusidium coccineum''. It was first isolated in 1960 and developed by Leo Pharma in Ballerup, Denmark, being used clinically from 1962 onwards.<ref name="Godtfredsen">{{cite journal | vauthors = Godtfredsen WO, Jahnsen S, Lorck H, Roholt K, Tybring L | title = Fusidic acid: a new antibiotic | journal = Nature | volume = 193 | issue = 4819 | pages = 987 | date = March 1962 | pmid = 13899435 | doi = 10.1038/193987a0 | doi-access = free | bibcode = 1962Natur.193..987G }}</ref><ref name="Huang">{{cite journal | vauthors = Huang X, Shen QK, Guo HY, Quan ZS, Li X |date=2023 |title=Research, development and pharmacological activity of fusidic acid and its derivatives |journal=Journal of Molecular Structure |volume=1291 |article-number=135942 |doi=10.1016/j.molstruc.2023.135942 |bibcode=2023JMoSt129135942H }}</ref> It has also been isolated from ''Mucor ramannianus'', an ''Acremonium'' species, and ''Isaria kogana''.<ref>{{cite journal | vauthors = Hikino H, Asada Y, Arihara S, Takemoto T |date=1972 |title=Fusidic Acid, a Steroidal Antibiotic from ''Isaria kogane'' |journal=Chemical and Pharmaceutical Bulletin |volume=20 |issue=5 |pages=1067–1069 |doi=10.1248/cpb.20.1067 |doi-access=free}}</ref><ref name="Wainwright">{{cite book | vauthors = Wainwright M |date=1992 |title=An Introduction to Fungal Biotechnology |location=Chichester |publisher=John Wiley & Sons |isbn=0471934585 |pages=54–55}}</ref> The drug is licensed for use as its sodium salt '''sodium fusidate''', and it is approved for use under prescription in Australia, Canada, Colombia, the European Union, India, Japan, New Zealand, South Korea, Taiwan, Thailand,{{citation needed|date=May 2024}} and the United Kingdom.<ref name="NHS"/>

== Mechanism of action == Fusidic acid binds to EF-G after translocation and GTP (guanosine-5'-triphosphate) hydrolysis.<ref>{{cite journal | vauthors = Bodley JW, Zieve FJ, Lin L, Zieve ST | title = Formation of the ribosome-G factor-GDP complex in the presence of fusidic acid | journal = Biochemical and Biophysical Research Communications | volume = 37 | issue = 3 | pages = 437–443 | date = October 1969 | pmid = 4900137 | doi = 10.1016/0006-291X(69)90934-6 | bibcode = 1969BBRC...37..437B }}</ref> This interaction prevents the necessary conformational changes for EF-G release from the ribosome, effectively blocking the protein synthesis process. Fusidic acid can only bind to EF-G in the ribosome after GTP hydrolysis.<ref>{{cite journal | vauthors = Gao YG, Selmer M, Dunham CM, Weixlbaumer A, Kelley AC, Ramakrishnan V | title = The structure of the ribosome with elongation factor G trapped in the posttranslocational state | journal = Science | volume = 326 | issue = 5953 | pages = 694–699 | date = October 2009 | pmid = 19833919 | pmc = 3763468 | doi = 10.1126/science.1179709 | bibcode = 2009Sci...326..694G }}</ref><ref>{{cite journal | vauthors = Seo HS, Abedin S, Kamp D, Wilson DN, Nierhaus KH, Cooperman BS | title = EF-G-dependent GTPase on the ribosome. conformational change and fusidic acid inhibition | journal = Biochemistry | volume = 45 | issue = 8 | pages = 2504–2514 | date = February 2006 | pmid = 16489743 | doi = 10.1021/bi0516677 }}</ref>

Since translocation is a part of elongation and ribosome recycling, fusidic acid can block either or both steps of protein synthesis.<ref>{{cite journal | vauthors = Savelsbergh A, Rodnina MV, Wintermeyer W | title = Distinct functions of elongation factor G in ribosome recycling and translocation | journal = RNA | volume = 15 | issue = 5 | pages = 772–780 | date = May 2009 | pmid = 19324963 | pmc = 2673078 | doi = 10.1261/rna.1592509 }}</ref>

==Dose== Fusidic acid should not be used on its own to treat ''S. aureus'' infections when used at low drug dosages. However, it may be possible to use fusidic acid as monotherapy when used at higher doses.<ref name="Moriarty" /> The use of topical preparations (skin creams and eye ointments) containing fusidic acid is strongly associated with the development of resistance,<ref>{{cite journal | vauthors = Mason BW, Howard AJ, Magee JT | title = Fusidic acid resistance in community isolates of methicillin-susceptible Staphylococcus aureus and fusidic acid prescribing | journal = The Journal of Antimicrobial Chemotherapy | volume = 51 | issue = 4 | pages = 1033–1036 | date = April 2003 | pmid = 12654748 | doi = 10.1093/jac/dkg190 | doi-access = free | title-link = doi }}</ref> and there are voices advocating against the continued use of fusidic acid monotherapy in the community.<ref name="Howden2006"/> Topical preparations used in Europe often contain fusidic acid and gentamicin in combination, which helps to prevent the development of resistance.

===Cautions===

There is inadequate evidence of safety in human pregnancy. Animal studies and many years of clinical experience suggest that fusidic acid is devoid of teratogenic effects (birth defects), but fusidic acid can cross the placental barrier.<ref>{{cite web | url = http://emc.medicines.org.uk/emc/assets/c/html/displaydoc.asp?documentid=2448#PRODUCTINFO | title = ''Fucidin'' UK data sheet | work = Electronic Medicines Compendium | date = June 1997 | archive-url = https://web.archive.org/web/20080611072314/http://emc.medicines.org.uk/emc/assets/c/html/displaydoc.asp?documentid=2448#PRODUCTINFO | archive-date=11 June 2008 }}</ref>

==Resistance== In vitro susceptibility studies of US strains of several bacterial species such as ''S. aureus'', including MRSA and coagulase negative ''Staphylococcus'', indicate potent activity against these pathogens.<ref>{{cite journal | vauthors = Castanheira M, Watters AA, Bell JM, Turnidge JD, Jones RN | title = Fusidic acid resistance rates and prevalence of resistance mechanisms among Staphylococcus spp. isolated in North America and Australia, 2007-2008 | journal = Antimicrobial Agents and Chemotherapy | volume = 54 | issue = 9 | pages = 3614–3617 | date = September 2010 | pmid = 20566766 | pmc = 2934946 | doi = 10.1128/aac.01390-09 }}</ref><ref>{{cite journal | vauthors = Pfaller MA, Castanheira M, Sader HS, Jones RN | title = Evaluation of the activity of fusidic acid tested against contemporary Gram-positive clinical isolates from the USA and Canada | journal = International Journal of Antimicrobial Agents | volume = 35 | issue = 3 | pages = 282–287 | date = March 2010 | pmid = 20036520 | doi = 10.1016/j.ijantimicag.2009.10.023 }}</ref><ref>Castanheira M, Mendes RE, Rhomberg PR and Jones RN (2010). Activity of fusidic acid tested against contemporary ''Staphylococcus aureus'' collected from United States hospitals. Infectious Diseases Society of America, 48th Annual Meeting, Abstract 226.</ref>

Mechanisms of resistance have been extensively studied only in ''Staphylococcus aureus''. The most studied mechanism is the development of point mutations in ''fusA'', the chromosomal gene that codes for EF-G. The mutation alters EF-G so that fusidic acid is no longer able to bind to it.<ref>{{cite journal | vauthors = Turnidge J, Collignon P | title = Resistance to fusidic acid | journal = International Journal of Antimicrobial Agents | volume = 12 | issue = Suppl 2 | pages = S35–S44 | date = August 1999 | pmid = 10528785 | doi = 10.1016/S0924-8579(98)00072-7 }}</ref><ref>{{cite journal | vauthors = Besier S, Ludwig A, Brade V, Wichelhaus TA | title = Molecular analysis of fusidic acid resistance in Staphylococcus aureus | journal = Molecular Microbiology | volume = 47 | issue = 2 | pages = 463–469 | date = January 2003 | pmid = 12519196 | doi = 10.1046/j.1365-2958.2003.03307.x | s2cid = 31240369 }}</ref> Resistance is readily acquired when fusidic acid is used alone and commonly develops during the course of treatment. As with most other antibiotics, resistance to fusidic acid arises less frequently when used in combination with other drugs. For this reason, fusidic acid should not be used on its own to treat serious ''Staph. aureus'' infections. However, at least in Canadian hospitals, data collected between 1999 and 2005 showed rather low rate of resistance of both methicillin-susceptible and methicillin-resistant to fusidic acid, and mupirocin was found to be the more problematic topical antibiotic for the aforementioned conditions.<ref>{{cite journal | vauthors = Rennie RP | title = Susceptibility of Staphylococcus aureus to fusidic acid: Canadian data | journal = Journal of Cutaneous Medicine and Surgery | volume = 10 | issue = 6 | pages = 277–280 | year = 2006 | pmid = 17241597 | doi = 10.2310/7750.2006.00064 | s2cid = 22919577 }}</ref>

Some bacteria also display 'FusB-type' resistance, which has been found to be the most prevalent in ''Staphylococcus spp.'' in many clinical isolates.<ref>{{cite journal | vauthors = Castanheira M, Watters AA, Mendes RE, Farrell DJ, Jones RN | title = Occurrence and molecular characterization of fusidic acid resistance mechanisms among Staphylococcus spp. from European countries (2008) | journal = The Journal of Antimicrobial Chemotherapy | volume = 65 | issue = 7 | pages = 1353–1358 | date = July 2010 | pmid = 20430787 | doi = 10.1093/jac/dkq094 | doi-access = free | title-link = doi }}</ref><ref>{{cite journal | vauthors = McLaws FB, Larsen AR, Skov RL, Chopra I, O'Neill AJ | title = Distribution of fusidic acid resistance determinants in methicillin-resistant Staphylococcus aureus | journal = Antimicrobial Agents and Chemotherapy | volume = 55 | issue = 3 | pages = 1173–1176 | date = March 2011 | pmid = 21149625 | doi = 10.1128/AAC.00817-10 | pmc = 3067117 }}</ref><ref>{{cite journal | vauthors = Castanheira M, Watters AA, Bell JM, Turnidge JD, Jones RN | title = Fusidic acid resistance rates and prevalence of resistance mechanisms among Staphylococcus spp. isolated in North America and Australia, 2007-2008 | journal = Antimicrobial Agents and Chemotherapy | volume = 54 | issue = 9 | pages = 3614–3617 | date = September 2010 | pmid = 20566766 | pmc = 2934946 | doi = 10.1128/AAC.01390-09 }}</ref> This resistance mechanism is mediated by fusB, fusC, and fusD genes found primarily on plasmids,<ref>{{cite journal | vauthors = O'Neill AJ, McLaws F, Kahlmeter G, Henriksen AS, Chopra I | title = Genetic basis of resistance to fusidic acid in staphylococci | journal = Antimicrobial Agents and Chemotherapy | volume = 51 | issue = 5 | pages = 1737–1740 | date = May 2007 | pmid = 17325218 | pmc = 1855526 | doi = 10.1128/AAC.01542-06 | doi-access = free | title-link = doi }}</ref> but have also been found in chromosomal DNA.<ref>{{cite journal | vauthors = O'Neill AJ, Larsen AR, Henriksen AS, Chopra I | title = A fusidic acid-resistant epidemic strain of Staphylococcus aureus carries the fusB determinant, whereas fusA mutations are prevalent in other resistant isolates | journal = Antimicrobial Agents and Chemotherapy | volume = 48 | issue = 9 | pages = 3594–3597 | date = September 2004 | pmid = 15328136 | pmc = 514786 | doi = 10.1128/AAC.48.9.3594-3597.2004 }}</ref> The product of fusB-type resistance genes is a 213-residue cytoplasmic protein which interacts in a 1:1 ratio with EF-G. FusB-type proteins bind in a region distinct from fusidic acid to induce a conformational change which results in liberation of EF-G from the ribosome, allowing the elongation factor to participate in another round of ribosome translocation.<ref>{{cite journal | vauthors = Cox G, Thompson GS, Jenkins HT, Peske F, Savelsbergh A, Rodnina MV, Wintermeyer W, Homans SW, Edwards TA, O'Neill AJ | title = Ribosome clearance by FusB-type proteins mediates resistance to the antibiotic fusidic acid | journal = Proceedings of the National Academy of Sciences of the United States of America | volume = 109 | issue = 6 | pages = 2102–2107 | date = February 2012 | pmid = 22308410 | pmc = 3277530 | doi = 10.1073/pnas.1117275109 | doi-access = free | title-link = doi | bibcode = 2012PNAS..109.2102C }}</ref>

== Interactions ==

Fusidic acid should not be used with quinolone antibiotics, with which it is antagonistic. Although clinical practice over the past decade has supported the combination of fusidic acid and rifampicin, a recent clinical trial showed that there is an antagonistic interaction when both antibiotics are combined.<ref>{{cite journal | vauthors = Pushkin R, Iglesias-Ussel MD, Keedy K, MacLauchlin C, Mould DR, Berkowitz R, Kreuzer S, Darouiche R, Oldach D, Fernandes P | title = A Randomized Study Evaluating Oral Fusidic Acid (CEM-102) in Combination With Oral Rifampin Compared With Standard-of-Care Antibiotics for Treatment of Prosthetic Joint Infections: A Newly Identified Drug-Drug Interaction | journal = Clinical Infectious Diseases | volume = 63 | issue = 12 | pages = 1599–1604 | date = December 2016 | pmid = 27682068 | doi = 10.1093/cid/ciw665 | doi-access = free | title-link = doi }}</ref>

On 8 August 2008, it was reported that the Irish Medicines Board was investigating the death of a 59-year-old Irish man who developed rhabdomyolysis after combining atorvastatin and fusidic acid, and three similar cases.<ref>{{cite news| url=http://www.independent.ie/national-news/man-died-after-rare-medical-reaction-to-cholesterol-drug-1449275.html | work=Irish Independent | vauthors = Riegel R | title=Man died after rare medical reaction to cholesterol drug | date=8 August 2008}}</ref> In August 2011, the UK's Medicines and Healthcare products Regulatory Agency issued a Drug Safety Update warning that "systemic fusidic acid (Fucidin) should not be given with statins because of a risk of serious and potentially fatal rhabdomyolysis."<ref>{{Cite web |title=Systemic fusidic acid and interaction with statins |url=https://www.gov.uk/drug-safety-update/systemic-fusidic-acid-and-interaction-with-statins#risk-of-rhabdomyolysis |url-status=live |archive-url=https://web.archive.org/web/20230510121813/https://www.gov.uk/drug-safety-update/systemic-fusidic-acid-and-interaction-with-statins#risk-of-rhabdomyolysis |archive-date=10 May 2023 |access-date=10 May 2023 |website=gov.uk }}</ref>

== Society and culture == === Brand names and preparations === {{div col|colwidth=30em}} * Fucidin (of Leo in Canada and Belgium) * Fucidin H (topical cream with hydrocortisone - Leo) * Fucidin (of Leo in UK/ Leo-Ranbaxy-Croslands in India) * Fuci-Ophthalmic (As eye gel in Damascus, Syria) * Fucidine (of Leo in France, Germany and Spain) * Fusicutan Creme (topical cream in Germany) * Fucidin (of Leo in Norway and Israel) * Fucidin (of Adcock Ingram, licensed from Leo, in South Africa) * Fucithalmic (of Leo in the UK, the Netherlands, Denmark and Portugal) * Fucicort (topical mixture with hydrocortisone) * Fucibet (fusidic acid/betamethasone valerate topical cream) * Ezaderm (topical mixture with betamethasone)(of United Pharmaceutical "UPM" in Jordan) * Fuci (of pharopharm in Egypt) * Fucizon (topical mixture with hydrocortisone of pharopharm in Egypt) * Foban (topical cream in New Zealand) * Betafusin (fusidic acid/betamethasone valerate topical cream in Greece) * Betafucin (2% fusidic acid/1% betamethasone valerate topical cream in Egypt)(of Delta Pharma S.A.E., A.R.E. (Egypt)) * Fusimax (of Roussette in India) * Fusiderm (topical cream and ointment by Indi Pharma in India) * Fusid (in Nepal) * Fudic (topical cream in India) * Tosidic (2% fusidic acid cream), of T.O.CHEMICALS (1979) in Thailand * Fucidin ({{lang|ko|후시딘}}, of Donghwa Pharm in South Korea) * Dermy (Topical cream of W. Woodwards in Pakistan) * Fugen Cream ({{lang|zh|膚即淨軟膏}} in Taiwan) * Phudicin Cream (in China; 夫西地酸<ref>{{cite web |url=http://www.pfb.org.cn/catalog/antimicrobial/20100204085231859.htm |title=奥络说明书, 奥络疗效,作用机制,副作用 | work = 广州皮肤病专科药房 | trans-title = Olo Instructions, Olo Efficacy, Mechanism of Action, Side Effects | trans-work = Guangzhou Dermatology Pharmacy |access-date=28 September 2010 |url-status=dead |archive-url=https://web.archive.org/web/20110707050305/http://www.pfb.org.cn/catalog/antimicrobial/20100204085231859.htm |archive-date=7 July 2011 }}</ref>) * Fucidin Fusidic Acid (in China;夫西地酸 of Leo Laoratories Limited) * Dermofucin cream, ointment and gel (in Jordan) * Optifucin viscous eye drops (of API in Jordan) * Verutex (of Roche in Brazil) * Taksta (of Cempra in U.S. For export only in US) * Futasole (of Julphar in Gulf and north Africa) * Stanicid (2% ointment of Hemofarm in Serbia) * Staphiderm Cream (Israel By Trima). * Fuzidin (tablets of Biosintez in Russia) * Fuzimet (ointment with methyluracil of Biosintez in Russia) * Axcel Fusidic Acid (2% cream and ointment of Kotra Pharma, Malaysia) * Ofusidic (eye drops produced by Orchidia pharmaceutical in Egypt {{div col end}}

== Research == An orally administered mono-therapy with a high loading dose is under development in the United States.<ref name="Moriarty" />

A different oral dosing regimen, based on the compound's pharmacokinetic/pharmacodynamic (PK-PD) profile is in clinical development in the US.<ref name="Moriarty">Moriarty SR, Clark K, Scott D, Degenhardt TP, Fernandes P, Craft JC, Corey GR, Still JG and Das A (2010). 50th Interscience Conference on Antimicrobial Agents and Chemotherapy, Abstract L1-1762</ref> as Taksta.<ref>{{cite press release | title=FDA Grants Qualified Infectious Disease Product Designation to Taksta Cempra's Fusidic Acid Antibiotic | publisher=Melinta Therapeutics | via=GlobeNewswire | date=18 September 2015 | url=https://www.globenewswire.com/en/news-release/2015/09/18/769296/26624/en/FDA-Grants-Qualified-Infectious-Disease-Product-Designation-to-Taksta-TM-Cempra-s-Fusidic-Acid-Antibiotic.html | access-date=5 May 2024}}</ref>

Fusidic acid is being tested for indications beyond skin infections. There is evidence from compassionate use cases that fusidic acid may be effective in the treatment of patients with prosthetic joint-related chronic osteomyelitis.<ref name="pmid21546631">{{cite journal | vauthors = Wolfe CR | title = Case report: treatment of chronic osteomyelitis | journal = Clinical Infectious Diseases | volume = 52 | issue = Suppl 7 | pages = S538–41 | date = June 2011 | pmid = 21546631 | doi = 10.1093/cid/cir169 }}</ref>

== Biosynthesis == The biosynthetic machinery in ''Fusidium coccineum'' (also known as ''Acremonium fusidioides'') has been sequenced and analyzed. (3S)-2,3-oxidosqualene and fusidane are two intermediates.<ref>{{cite journal | vauthors = Cao Z, Li S, Lv J, Gao H, Chen G, Awakawa T, Abe I, Yao X, Hu D | title = Biosynthesis of clinically used antibiotic fusidic acid and identification of two short-chain dehydrogenase/reductases with converse stereoselectivity | journal = Acta Pharmaceutica Sinica. B | volume = 9 | issue = 2 | pages = 433–442 | date = March 2019 | pmid = 30972287 | doi = 10.1016/j.apsb.2018.10.007 | doi-access = free| pmc = 6437595 }}</ref><ref>{{cite journal | vauthors = Li X, Cheng J, Liu X, Guo X, Liu Y, Fan W, Lu L, Ma Y, Liu T, Tao S, Jiang H | title = Origin and Evolution of Fusidane-Type Antibiotics Biosynthetic Pathway through Multiple Horizontal Gene Transfers | journal = Genome Biology and Evolution | volume = 12 | issue = 10 | pages = 1830–1840 | date = October 2020 | pmid = 32915993 | doi = 10.1093/gbe/evaa163 | pmc = 7750971 }}</ref>

== References == {{reflist}}

== External links == {{commons category|Fusidic acid}}

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{{DEFAULTSORT:Fusidic Acid}} Category:Alkene derivatives Category:CYP2D6 inhibitors Category:Diols Category:Acetate esters Category:Steroid antibiotics Category:Carboxylic acids Category:Protein synthesis inhibitor antibiotics Category:Tetracyclic compounds