Secondary bacterial infection of eczema and other common skin conditions: antimicrobial prescribing

Efficacy of oral antibiotics

Evidence was from 1 systematic review of RCTs.

There were no statistically significant differences in clinical effectiveness, quality of life or microbiological outcomes for oral flucloxacillin compared with placebo in children with infected eczema. Both groups had corticosteroids and were encouraged to use emollients.

Some differences were seen in the presence of clinically apparent infection (definition unclear) at the end of treatment for oral cefadroxil compared with placebo in children with infected eczema (it was unclear whether topical corticosteroids were used in either group). However, there were no statistically significant differences in other clinical-effectiveness outcomes.

There were no differences in adverse events or withdrawals caused by adverse events for oral antibiotics (flucloxacillin or cefadroxil) compared with placebo in children with infected eczema.

Efficacy of topical antibiotics

Evidence for efficacy of topical antibiotics was from 1 systematic review of RCTs.

Some statistically significant differences were seen for the following comparison in children with infected eczema:

There were no statistically significant differences in other quality of life, clinical-effectiveness or microbiological outcomes for the same comparison.

There were no statistically significant differences in clinical outcome for topical gentamicin plus a topical corticosteroid (betamethasone valerate) compared with a topical corticosteroid (betamethasone valerate) alone in children with infected eczema.

There were no statistically significant differences in microbiological outcomes for a topical antibiotic (fusidic acid or gentamicin) plus a topical corticosteroid (clobetasone butyrate, hydrocortisone or betamethasone valerate) compared with a topical corticosteroid (clobetasone butyrate, hydrocortisone or betamethasone valerate) alone in people (age not reported) with infected eczema.

There were no differences in adverse events for topical fusidic acid plus a topical corticosteroid (clobetasone butyrate or hydrocortisone) compared with a topical corticosteroid (clobetasone butyrate or hydrocortisone) alone in children with infected eczema.

Efficacy of an antibiotic and corticosteroid combination compared with placebo alone

Evidence for efficacy of an antibiotic and corticosteroid combination compared with placebo alone was from 1 RCT.

Topical fusidic acid plus a topical corticosteroid (betamethasone valerate) was statistically significantly more effective than placebo for several 'responders' (people with a marked improvement or complete clearance of their eczema) and for several people with a successful biological response (baseline pathogen eradication or no visible target lesions) in children aged over 6 years, young people and adults. It was also statistically significantly more effective in terms of total severity score at end of treatment. There were no statistically significant differences in microbiological outcomes for the same comparison.

There were no differences in the number of people reporting adverse events for topical fusidic acid plus a topical corticosteroid (betamethasone valerate) compared with placebo in children with infected eczema. However, statistically significantly fewer people reported adverse drug reactions with topical fusidic acid plus a topical corticosteroid than with placebo.

Efficacy of topical antiseptics

Evidence was from 1 systematic review of RCTs.

The study did not report any data (no event rates), so no conclusions could be made about the differences in clinical effectiveness for triclosan and benzalkonium chloride emollient in bath water compared with non-antimicrobial emollient in bath water in children with infected eczema.

Efficacy of intranasal antibiotic with a bleach bath

Evidence was from 1 systematic review of RCTs.

Intranasal mupirocin (for decolonisation) plus a bleach bath was statistically significantly more effective than placebo in children with infected eczema for:

There were no statistically significant differences in microbiological outcomes, withdrawals due to adverse events or minor adverse events for the same comparison.

Antibiotic resistance

Oral antibiotics

No evidence was identified for choice of oral antibiotic.

Topical antibiotics

In 1 RCT, topical fusidic acid plus a topical corticosteroid (halometasone) was statistically significantly more effective than neomycin sulfate plus a topical corticosteroid (betamethasone) in reducing the number of people with a positive bacterial culture at day 10 or end of treatment (20 or 30 days) in adults with infected eczema. There were no statistically significant differences in clinical effectiveness or adverse events for the same comparison.

Oral antibiotic compared with topical antibiotic

In 1 RCT, there were no statistically significant differences between topical fusidic acid and oral flucloxacillin (both groups had topical corticosteroids) in clinical-effectiveness outcomes, adverse events or healthcare use in children with infected eczema.

In 1 RCT, topical mupirocin was statistically significantly more effective than oral cefalexin at eradicating or improving S. aureus isolates in children aged over 8 years, young people and adults with infected eczema. Patient preference for treatment indicated that more people preferred topical treatment. There were no statistically significant differences in other microbiological outcomes, all clinical-effectiveness outcomes and adverse events for the same comparison.