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Antibiotics may not be beneficial for the Tx of clinically infected eczema in children

Researchers suggest that oral or topical antibiotics might not be effective for milder clinically infected eczema in children, according to findings published in The Annals of Family Medicine (Mar./Apr. 2017; 15(2):124–130).

“Topical antibiotics, often in combination products with topical corticosteroids, are frequently used to treat eczema flares,” said Dr. Nick Francis, lead investigator, and a clinical reader at Cardiff University in Wales, U.K., who was quoted in a press release.

The aim of the study was to find out if oral or topical antibiotics help improve eczema severity in children with infected eczema. All of the children included in this investigation also received standard eczema treatment with corticosteroids and emollients.

This three-arm, blinded, randomized controlled trial referred to as CREAM (ChildRen with Eczema, Antibiotic Management) involved 113 children with clinical, non-severely infected eczema who were randomized to receive oral and topical placebos (control), oral antibiotic (flucloxacillin) and topical placebo, or topical antibiotic (fusidic acid) and oral placebo, for one week.

During the investigation, the researchers also compared Patient-Oriented Eczema Measure (POEM) scores at two weeks using analysis of covariance (ANCOVA).

In the investigation, the 113 participants were divided into three groups consisting of a control group (n=40), an oral antibiotic group (n=36), and a topical antibiotic group (n=37).

At baseline, 104 children (93%) had one or more of the following findings: weeping, crusting, pustules, or painful skin. The mean (SD) POEM scores at two 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, the authors wrote.

The researchers added that controlling for baseline POEM score, neither oral nor topical antibiotics produced a significant difference in mean (95% CI) POEM scores (1.5 [−1.4 to 4.4] and 1.5 [−1.6 to 4.5] respectively). There were no significant differences in adverse effects and no serious adverse events.

“Our research shows that even if there are signs of infection, children with milder eczema are unlikely to benefit from antibiotics, and their use can promote resistance and allergy or skin sensitization,” added Dr. Francis, who is also a practicing general practitioner.

“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 concluded.

The CREAM trial was led by Dr. Francis, and Frank Sullivan PhD, a professor at the University of Toronto. It was coordinated by the Centre for Trials Research at Cardiff University in Wales, U.K., and in collaboration with colleagues at University of Bristol in Bristol, U.K.; University of Oxford in Oxford, England; University of Dundee in Dundee, Scotland; Swansea University in Wales, UK; and Public Health Wales, UK.

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