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Dear Readers! I started this blog when my daughter was in the NICU. She had ventriculitis. Her CSF report grew E.coli. But, she was injected Teicoplanin directly into her brain. The doctors made two errors here:

Teicoplanin is for gram-positive bacteria only. It does not treat E.coli.
Teicoplanin is not for intraventricular use. The manufacturer strongly discourage injecting Teicoplanin into the brain.

My daughter bled into the brain. She lived for another two years and ultimately died.

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Novacort (Pramoxine and hydrocortisone) - Uses, Dose, Brands

Novacort (Pramoxine and hydrocortisone) is a combination of a local anesthetic drug and a corticosteroid. It is used to relieve inflammation, itching, and pruritis associated with local skin conditions such as eczema.

Pramoxine and hydrocortisone Uses:

Dermatoses:
- It is used for the symptomatic treatment of corticosteroid-responsive dermatoses. It relieves inflammation and pruritis associated with dermatosis and eczema.

Novacort (Pramoxine and hydrocortisone) Dose in Adults

Novacort (Pramoxine and hydrocortisone) Dose in the treatment of Dermatoses:

Topical, rectal:
- Apply to affected areas three or four times a day.

Dose in Children:

Refer to adults' dosing.

Pregnancy Risk Factor C

Corticosteroids have been shown to cause adverse pregnancy outcomes in animal reproduction studies.
It was safe to use rectally to treat haemorrhoids during the third trimester.
Also, refer to the topical hydrocortisone monograph.

Use of hydrocortisone and pramoxine during lactation

Refer to topical hydrocortisone monograph.

Dose in Kidney disease:

There are no dosage adjustments provided in the manufacturer’s labeling.

Dose in Liver disease:

There are no dosage adjustments provided in the manufacturer’s labeling.

Side effects of Pramoxine and hydrocortisone Cream:

See Individual agents (Pramoxine and Hydrocortisone)

Contraindications to Novacort (Pramoxine and hydrocortisone):

Allergy to pramoxine, hydrocortisone, or any other ingredient in the formulation

Cautions and Alerts

Suppression of the adrenals:
- Hypothalamic-pituitary-adrenal (HPA) axis suppression may occur in young children and individuals receiving long-term high doses. Patients who have suppressed adrenal function are more vulnerable.
Immunosuppression:
- Long-term use or prolonged use of a large body surface may cause immunosuppression, which may make the patient more susceptible to fungal and bacterial superinfections.
- Superinfections are a sign that a patient should stop receiving treatment and seek proper antimicrobial treatment.
Contact dermatitis:
- It is possible to contract contact dermatitis, which can lead to a paradoxical worsening. It is important to stop using the treatment and get it under control.
Systemic effects
- Topical corticosteroids can be absorbed and cause side effects. Cushing's syndrome was reported in patients who were given higher doses of corticosteroids for a longer time.
- The occlusive dressing, long-term therapy, and the use of large areas of treatment can also increase absorption.

Pramoxine and hydrocortisone: Drug Interaction

Risk Factor C (Monitor therapy)
Calcipotriene	Calcipotriene's medicinal effects may be diminished by topical hydrocortisone. Management: If using hydrocortisone valerate in combination with calcipotriene, watch for diminished potency. To reduce the danger of this potential interaction, think about administering these drugs 10 to 12 hours apart.
Corticorelin	The therapeutic benefit of corticorelin may be reduced by corticosteroids. In particular, recent or ongoing corticosteroid medication may reduce the plasma ACTH response to corticorelin.
Deferasirox	Corticosteroids may intensify Deferasirox's negative/toxic effects. Particularly, there may be a higher risk of GI bleeding or ulcers.
Methemoglobinemia Associated Agents	Could make local anaesthetics more harmful or poisonous. In particular, there may be an elevated risk for methemoglobinemia.
Ritodrine	Corticosteroids may intensify Ritodrine's harmful or hazardous effects.
Risk Factor D (Consider therapy modification)
Hyaluronidase	The therapeutic benefit of hyaluronidase may be reduced by corticosteroids. Treatment: Standard doses of hyaluronidase may not produce the desired clinical response in patients using corticosteroids (especially at higher doses). Hyaluronidase may be needed at higher doses.
Risk Factor X (Avoid combination)
Aldesleukin	The anti-cancer effects of corticosteroids may be diminished by aldesleukin.

Monitoring parameters:

The development of Cushing's syndrome, hypercortisolism, and suppression of the HPA axis may all be kept an eye on in patients.
In individuals with suspected hypothalamic-pituitary-adrenal (HPA) axis suppression, a urinary-free cortisol test and an ACTH stimulation test may be performed.

How to administer Novacort (Pramoxine and hydrocortisone)?

Topical:

To the region, smear a light coating of sunscreen. To the affected area, apply a thin film.
Occlusive dressings can be used for patients suffering from recalcitrant or severe psoriasis.
The occlusive dressing must be removed if the skin becomes infected. Antimicrobial treatment should also be initiated.
Patients need to be told not to wear diapers and form-fitting clothing.

Foam: Epifoam

The medicated foam should be shaken vigorously for five to ten seconds before you use it.
The medicated foam can then be applied directly to the affected areas or indirectly by being dispensed onto a pad.
The container should never be inserted into the rectum or vaginal area.
After each usage, the container and cap must be taken off and washed with warm water.
Shake the lotion thoroughly prior to use.

Rectal: Proctofoam HC:

Before using the rectal proctofoam, shake it vigorously for 5-10 seconds. It is important not to remove the cap.
To fill the applicator, the container must be held straight up and gently inserted into its anus. Use the applicator supplied by the manufacturer.
It's crucial to avoid putting any aerosol canister within the anus. Wash the applicator with warm water after use. Use the applicator to apply a tiny amount to the affected perianal area.