Cardiff, Wales—Prescribing antibiotics for eczema flares is fairly common practice, with an estimated 40% treated with the topical formulation.
New research published in the Annals of Family Medicine suggests, however, that use of either oral or topical antibiotics offers no meaningful benefit for milder, clinically infected eczema in children.
To determine that, University of Cardiff–led researchers analyzed data from 113 children with nonseverely infected eczema who were randomized to one of three study arms:
• Oral and topical placebos
• Oral antibiotic (flucloxacillin) and topical placebo, or
• Topical antibiotic (fusidic acid) and oral placebo.
After a week’s treatment, no significant differences were detected among the three groups in the resolution of eczema symptoms at 2 weeks, 4 weeks, or 3 months. On the other hand, rapid resolution occurred in response to mild-to-moderate strength topical corticosteroids and emollient treatment, but meaningful benefit from the addition of either oral or topical antibiotics was ruled out.
At baseline, most—93%—of the children had one or more of the following symptoms: weeping, crusting, pustules, or painful skin. Mean (SD) patient-oriented eczema measure (POEM) scores at 2 weeks were 6.2 (6.0) for control, 8.3 (7.3) for the oral antibiotic group, and 9.3 (6.2) for the topical antibiotic group.
Controlling for baseline POEM score, neither oral nor topical antibiotics produced a significant difference in mean POEM scores, both 1.5. At the same time, there also were no significant differences in adverse effects and no serious adverse events, according to the study.
The researchers suggest, in fact, that antibiotics can actually promote resistance and allergy or skin sensitization.
“We found rapid resolution in response to topical steroid and emollient treatment and ruled out a clinically meaningful benefit from the addition of either oral or topical antibiotics,” study authors conclude. “Children seen in ambulatory care with mild clinically infected eczema do not need treatment with antibiotics.”
The authors emphasize that the study excluded patients with severe infection, and that the results might not be generalizable to all children with clinically infected eczema.
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