Are Antibiotics Effective for the Treatment of Infected Eczema in Children?

The addition of oral and topical antibiotics to treat infected eczema in children showed no benefit over topical emollient and corticosteroids alone, according to a recent study.

In order to determine the effect of oral and topical antibiotics for the treatment of clinically infected eczema, the researchers conducted a 3-arm, blinded, randomized controlled trial involving 113 children in the United Kingdom. Forty children were randomly assigned to receive oral and topical placebos (control), 36 children were randomly assigned to receive an oral antibiotic (flucloxacillin) and topical placebo, and 37 were randomly assigned to receive a topical antibiotic (fusidic acid) and oral placebo.
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The patients, all of which had clinical, non-severely infected eczema, were treated for 1 week. Patient Oriented Eczema Measure (POEM) scores were compared at 2 weeks using analysis of covariance.

The mean standard deviation (SD) baseline POEM scores were 13.4 (5.1) for the control group, 14.6 (5.3) for the oral antibiotic group, and 16.9 (5.5) for the topical antibiotic group. In addition, 104 children (93%) had 1 or more of the following: weeping skin, crusting skin, pustules, or painful skin. 

At 2 weeks, the mean (SD) POEM scores were 6.2 (6.0) for the control group, 8.3 (7.3) for the oral antibiotic group, and 9.3 (6.2) for the topical antibiotic group.

After controlling for baseline POEM scores, the researchers found that oral and topical antibiotics did not produce significant differences in mean POEM scores (1.5 [−1.4 to 4.4] and 1.5 [−1.6 to 4.5] respectively).

“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. Children seen in ambulatory care with mild clinically infected eczema do not need treatment with antibiotics,” the researchers concluded.

—Melissa Weiss

Reference:

Francis NA, Ridd MJ, Thomas-Jones E, et al. Oral and topical antibiotics for clinically infected eczema in children: a pragmatic randomized controlled trial in ambulatory care. Ann Fam Med. 2017;15(2):214-130.