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Antibiotics ineffective for clinically infected eczema

Antibiotics demonstrated no clinically meaningful benefit for treating clinically infected eczema when compared to topical corticosteroids and emollient treatment, according to research recently published in the Annals of Family Medicine.

“Staphylococcus aureus can be isolated from lesional skin in about 70% of patients with eczema. The odds of colonization are nearly 20 times those in people without eczema, and more severe eczema is associated with higher organism density,” Nick A. Francis, MD, PhD, from the School of Medicine at Cardiff University, and colleagues wrote. “Despite the clear association between eczema and the presence of S. aureus, however, there is uncertainty about what constitutes infection and when antibiotic treatments are likely to confer benefit.”

To determine the antibiotic benefit to children with clinically infected eczema, Francis and colleagues randomly assigned 113 children aged 3 months to 7 years into one of three groups: topical antibiotic (fusidic acid) and oral placebo, oral antibiotic (flucloxacillin) and topical placebo, and control (oral and topical placebos). The mean baseline Patient Oriented Eczema Measure scores were 16.9 for the topical antibiotic group, 14.6 for the oral antibiotic group and 13.4 for the control group. The mean age of the participants was 3 years.

The researchers found that at 2 weeks, the mean Patient Oriented Eczema Measure scores were 9.3 for the topical antibiotic group, 8.3 for the oral antibiotic group and 6.2 for the control group. These scores at 4 weeks and 3 months also suggested that there was little, if any, benefit from taking oral or topical antibiotics.

“Children with clinically infected eczema flares in primary care recovered quickly with use of mild-to-moderate–strength topical corticosteroids and did not benefit from the addition of either oral or topical antibiotics,” Francis and colleagues wrote.

According to the researchers, vomiting, diarrhea and new rash were the only adverse events reported, and there were no significant differences in adverse effects among the three groups. In addition, they noted that very study few participants were minorities or aged older than 3 years, and thus, the results may not necessarily be applicable to patients in those population groups.

“Little has been published about the natural history of eczema flares, so our finding that symptomatic improvement occurs over the first week and then levels off provides what is probably the best available evidence about recovery from clinically infected eczema flares that are treated with topical corticosteroids and emollients,” Francis and colleagues wrote.

“The use of topical corticosteroids for eczema flares has a substantial evidence base, and participants recovered well with use of topical corticosteroids and emollients, so providing, or stepping up the potency of, topical corticosteroids and emollients should be the main focus in the care of milder clinically infected eczema flares.”– by Janel Miller

Disclosure: The researchers report no relevant financial disclosures.