Eczema: antibiotics ineffective for clinically infected eczema in children

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Experts say stepping up the potency of  topical corticosteroids and emollients should be the mainstay of treatment.

It is estimated that 40 per cent of eczema flares are treated with topical antibiotics. However, findings published this week in the Annals of Family Medicine suggest there is no meaningful benefit from the use of either oral or topical antibiotics for mild clinically infected eczema in children.

For the study, 113 children with clinical, non-severely infected eczema were randomised to receive oral and topical placebos, oral antibiotic and topical placebo, or topical antibiotic and oral placebo, for one week. Patient Oriented Eczema Measure (POEM) scores were compared at two weeks, with no significant differences between POEM scores in the intervention and control groups. POEM scores at four weeks and three months, and other secondary outcomes, all suggested minimal or no clinical benefit from oral or topical antibiotic.
However, the authors identified rapid resolution in response to topical steroid and emollient treatment. Lead author Dr Nick Francis, clinical reader at Cardiff University and primary care physician, said the research shows that even if there are signs of infection, children with milder eczema are unlikely to benefit from antibiotics. “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,” he said.

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