Balanitis (Acute Candidal & Bacterial)

Apply thin layer of 1% cream to glans penis and inner prepuce twice daily x 7-14 days

Apply thin layer twice daily for 7-14 days for candidal balanitis

Alternatives. Clotrimazole leads: the source names topical imidazoles, clotrimazole 1% and miconazole 2%, as the preferred first-line therapy, and gives nystatin only as the alternative for a patient allergic to imidazoles. Neither treats a bacterial infection.

BASHH UK National Guideline for the Management of Balanoposthitis 2018

Topical imidazole antifungal that disrupts the fungal cell membrane, treating the Candida overgrowth responsible for most balanitis; first-line for the candidal form.

Apply to the affected area twice daily - Until healing is complete

Apply to the affected area twice daily, the same as for an adult - the formulary states no weight-based topical dose.

Balanitis - StatPearls - NCBI Bookshelf (NBK537143) - disease-level clinical article (balanitis-full.txt) for the indication - verbatim: "Nystatin cream is an alternative for patients allergic to imidazoles." Dose from Egyptian National Drug Formulary - Antimicrobial 2023, nystatin monograph - verbatim, topical indication: "Fungal infections (cutaneous and mucocutaneous): Treatment of cutaneous and mucocutaneous fungal infections caused by Candida albicans and other susceptible Candida species", and dosing: "Cream, ointment: Apply to the affected areas twice daily or as indicated until healing is complete".

The antifungal for a man who cannot take an imidazole. Clotrimazole and miconazole are both imidazoles, so an allergy to one rules out both of the usual first-line creams. Nystatin is a different class, and is the source's named alternative.

150 mg single oral dose for severe or recurrent candidal balanitis - single dose

Specialist pediatric use only

Egyptian National Drug Formulary - Antimicrobial 2023 (fluconazole monograph)

Oral triazole antifungal used when topical antifungal treatment fails or is poorly tolerated in severe or recurrent candidal balanitis.

Apply thin layer of 1% cream twice daily for up to 7 days as anti-inflammatory adjunct for marked erythema and itching x up to 7 days

Apply thin layer twice daily for up to 5-7 days under medical advice

BASHH UK National Guideline for the Management of Balanoposthitis 2018

Low-potency topical corticosteroid added to the antifungal to calm marked erythema and itching; used alongside the antifungal, never as monotherapy, since a steroid alone would let an active fungal infection worsen.

Apply 2% cream or ointment three times daily x 7 to 14 days

Applied the same way in children - a topical dose is not weight-based.

Balanitis - StatPearls - NCBI Bookshelf (NBK537143) - disease-level clinical article (balanitis-full.txt) - verbatim: "Treatment with an oral antibiotic (dicloxacillin 500 mg or cephalexin QID × 7 days) and mupirocin topical cream applied TID for 7 to 14 days is appropriate if there is a concern for concomitant cellulitis or a secondary infection." The 2% strength is the only mupirocin marketed in Egypt.

Topical antibacterial cover where the glans looks secondarily infected rather than simply inflamed. The source pairs it with an oral antibiotic when cellulitis is a concern, not instead of one.

875/125 mg orally every 12 hours x 5 to 7 days

No weight-based dose here: the formulary sets paediatric co-amoxiclav by indication and states none for this one. Use cefalexin below for a child, which carries the formulary's general paediatric dose.

Alternatives, both for secondary bacterial infection or concomitant cellulitis - not for uncomplicated candidal balanitis, which needs the topical antifungal above and no antibiotic at all. Co-amoxiclav is put first on dosing practicality: twice a day against cefalexin's four times a day, for the same 7-day course. Cefalexin is the one to use in a child: it is the one of the two carrying a weight-based paediatric dose.

Balanitis - StatPearls - NCBI Bookshelf (NBK537143) - disease-level clinical article (balanitis-full.txt) for the indication - verbatim: "Anaerobic infections can be treated with metronidazole, whereas aerobic infections may be treated with oral cephalosporins, erythromycin, or amoxicillin/clavulanic acid." Dose from Egyptian National Drug Formulary - Antimicrobial 2023, amoxicillin and clavulanic acid monograph - verbatim indication "Skin and skin structure infections", and dosing: "Immediate release: 500 mg every 8 to 12 hours or 875 mg every 12 hours" with "Duration: 5 to 7 days for mild to moderate infection and 10 days for severe infection".

Oral cover for the aerobic bacterial balanoposthitis the card's title claims and never treated. Twice-daily dosing matters for a 7-day course in a well outpatient.

500 mg orally every 6 hours x 7 days

25-50 mg/kg/day [child max 2000 mg]

(25 to 50 mg/kg/day divided every 6 or 12 hours, maximum 2,000 mg/day (Egyptian National Drug Formulary, cephalexin monograph, general dosing for mild to moderate infection).)

Balanitis - StatPearls - NCBI Bookshelf (NBK537143) - disease-level clinical article (balanitis-full.txt) for the indication and the frequency and duration - verbatim: "Treatment with an oral antibiotic (dicloxacillin 500 mg or cephalexin QID × 7 days) and mupirocin topical cream applied TID for 7 to 14 days is appropriate if there is a concern for concomitant cellulitis or a secondary infection." The article gives no strength for cephalexin - the 500 mg is from Egyptian National Drug Formulary - Antimicrobial 2023, cephalexin monograph - verbatim indication "Skin and skin structure infections: Treatment of skin and skin structure infections caused by S. aureus and/or S. pyogenes", and dosing: "Usual adult dosage range: Oral: 250 to 1,000 mg every 6 hours or 500 mg every 12 hours (maximum: 4 g/day)". QID is every 6 hours, so 500 mg every 6 hours sits inside the formulary range at the article's frequency.

The cephalosporin option, and the one to use in a child - its paediatric dose is the formulary's general figure for mild to moderate infection.