Terra-Cortril

Terra-Cortril is a combination topical preparation containing two active ingredients: hydrocortisone 1% and oxytetracycline 3%. It combines a mild corticosteroid with a broad-spectrum antibiotic to treat inflammatory skin conditions that are complicated by, or at risk of, secondary bacterial infection. Terra-Cortril is available as a cream and is a prescription-only medicine in the UK.

Why Combine a Steroid and an Antibiotic?

Eczema, dermatitis, and other inflammatory skin conditions frequently become secondarily infected with bacteria - most commonly Staphylococcus aureus or Streptococcus species - when the skin's barrier is disrupted. Using a corticosteroid alone in this context risks suppressing the immune response and facilitating the spread of infection. Conversely, an antibiotic alone will not address the underlying inflammation. Terra-Cortril's combination formulation addresses both components simultaneously, reducing inflammation with hydrocortisone while oxytetracycline provides bacteriostatic action against the infecting organisms.

Conditions Treated

Terra-Cortril is indicated for infected eczema, infected contact dermatitis, infected seborrhoeic dermatitis, and other superficial bacterial skin infections in the context of inflammatory skin disease. It is particularly useful when there is clinical evidence of secondary bacterial infection, such as crusting, weeping, pustules, or rapidly worsening inflamed skin. It is not suitable as a first-line treatment for eczema without signs of infection, nor is it appropriate for purely bacterial infections (such as impetigo) where a standalone antibiotic would be more appropriate.

Limitations and Duration of Use

Terra-Cortril is intended for short-term use only - typically no more than two weeks. Prolonged use of combined steroid-antibiotic preparations risks antibiotic resistance and the side effects associated with topical steroid use. If the skin has not improved within two weeks, or if infection is spreading, the patient should be reviewed by a doctor.

Terra-Cortril cream is applied thinly to the affected area of skin twice daily. A thin layer covering the inflamed area is sufficient - excessive amounts do not increase efficacy and increase the risk of side effects from both the steroid and antibiotic components.

Practical Application

Wash hands before and after applying the cream, unless the hands are the area being treated. Apply a thin film to the affected skin, covering the area of inflammation and any visible signs of secondary infection such as crusting or pustules. Do not apply to the eyes, inside the nose, or to broken or ulcerated skin beyond what is already affected by the condition being treated.

Duration and Review

Treatment should be limited to two weeks. If the infected eczema has not resolved within this time, a doctor should reassess the diagnosis and consider whether a different antibiotic (based on swab results) or a stronger treatment is needed. Oxytetracycline resistance in Staphylococcus aureus is common, and treatment failure may indicate resistance. Do not use Terra-Cortril under occlusive dressings unless specifically directed by a dermatologist, as this significantly increases absorption of both active ingredients.

Standard adult dose: Apply thinly to the affected area twice daily.

Children: Use under medical supervision. Apply for the shortest time necessary. Avoid prolonged use in children due to the risk of systemic absorption from the corticosteroid component.

Maximum duration: Generally 2 weeks. Do not exceed without medical review.

Area of application: Limit to the affected area only. Avoid extensive use over large body surface areas to minimise systemic absorption of hydrocortisone.

Common Side Effects

• Skin irritation, burning, or stinging on application
• Skin dryness or peeling
• Skin thinning (atrophy) with prolonged use
• Contact sensitisation to oxytetracycline or hydrocortisone
• Mild photosensitivity - avoid prolonged sun exposure on treated areas
• Folliculitis

Serious Side Effects

• HPA axis suppression with prolonged use over large areas or under occlusion
• Antibiotic resistance - particularly of Staphylococcus aureus to oxytetracycline
• Spread or worsening of untreated viral or fungal skin infections masked by the steroid component
• Cushing's syndrome features with excessive long-term use
• Severe allergic reaction to either active ingredient

Terra-Cortril must not be used for longer than two weeks without medical review. The combination of an antibiotic and steroid in a single preparation, while convenient for short-term use, carries the risk of selecting for antibiotic-resistant bacteria if used repeatedly or for extended periods. Oxytetracycline-resistant Staphylococcus aureus is increasingly prevalent, and prolonged use of Terra-Cortril can contribute to this resistance.

Masking of Infection

The hydrocortisone component can mask signs of worsening infection, such as spreading erythema, warmth, and pain. If the skin condition deteriorates despite treatment, or if systemic signs of infection develop (fever, swollen lymph nodes), Terra-Cortril should be stopped and the patient should see a doctor promptly.

Pregnancy and Breastfeeding

Terra-Cortril contains oxytetracycline, a tetracycline antibiotic that is contraindicated in pregnancy (risk of foetal bone and tooth development problems) and in breastfeeding. It is also contraindicated in children under 12 because tetracyclines bind to developing bones and teeth, causing discolouration and inhibiting growth. Alternative treatments should be sought in these patient groups.

• Known hypersensitivity to hydrocortisone, oxytetracycline, or any excipient
• Pregnancy - tetracyclines are contraindicated
• Breastfeeding - tetracyclines pass into breast milk
• Children under 12 - tetracyclines affect bone and tooth development
• Untreated viral skin infections (e.g., herpes simplex, varicella)
• Untreated fungal skin infections
• Tuberculous skin lesions
• Rosacea, perioral dermatitis, or acne vulgaris
• Application to the face, perianal area, or genital skin
• Under occlusive dressings without specialist advice