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No benefit from using topical antibiotics for eczema

Findings from the CREAM study are that there is no meaningful benefit from the use of either oral or topical antibiotics for milder clinically infected eczema in children. Estimates suggest that 40% of eczema flares are treated with topical antibiotics.

Eczema is a common condition, especially in young children, and affects around 1 in 5 children in the UK. Eczema sometimes gets worse, or ‘flares’, and having particular bacteria on the skin may contribute to causing some of these flares. Quite often eczema flares are treated with antibiotics, although there was very little research to show whether antibiotics are helpful or not.

The CREAM study was designed to find out if oral (taken by mouth) or topical (creams and ointments applied to the skin) antibiotics help improve eczema severity in children with infected eczema. All children also received standard eczema treatment with steroid creams and emollients (moisturiser) from their doctor.

Results from the analysis of data from 113 children with non-severely infected eczema, showed no significant difference between the groups in the resolution of eczema symptoms at two weeks, four weeks or three months.

Researchers found rapid resolution in response to mild-to-moderate strength topical corticosteroids and emollient treatment, and ruled out a clinically meaningful benefit from the addition of either oral or topical antibiotics.

Dr Nick Francis, clinical reader at Cardiff University and practicing GP, who led the study said: “Topical antibiotics, often in combination products with topical corticosteroids, are frequently used to treat eczema flares…”

“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.”

The CREAM (ChildRen with Eczema, Antibiotic Management) study was led by Dr Nick Francis, division of population Medicine, Cardiff University and Professor Frank Sullivan, University of Toronto, coordinated by the Centre for Trials Research at Cardiff University, and in collaboration with colleagues at University of Bristol, University of Oxford, University of Dundee, Swansea University, and Public Health Wales.

The study was funded by the National Institute for Health Research Health Technology Assessment Programme.

Abstract
Purpose: Eczema may flare because of bacterial infection, but evidence supporting antibiotic treatment is of low quality. We aimed to determine the effect of oral and topical antibiotics in addition to topical emollient and corticosteroids in children with clinically infected eczema.
Methods: We employed a 3-arm, blinded, randomized controlled trial in UK ambulatory care. Children with clinical, non-severely infected eczema were randomized to receive oral and topical placebos (control), oral antibiotic (flucloxacillin) and topical placebo, or topical antibiotic (fusidic acid) and oral placebo, for 1 week. We compared Patient Oriented Eczema Measure (POEM) scores at 2 weeks using analysis of covariance (ANCOVA).
Results: We randomized 113 children (40 to control, 36 to oral antibiotic, and 37 to topical antibiotic). Mean (SD) baseline Patient Oriented Eczema Measure 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. At baseline, 104 children (93%) had 1 or more of the following findings: weeping, crusting, pustules, or painful skin. Mean (SD) 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 (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.
Conclusions: 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.

Authors
Nick A Francis, Matthew J Ridd, Emma Thomas-Jones, Christopher C Butler, Kerenza Hood, Victoria Shepherd, Charis A Marwick, Chao Huang, Mirella Longo, Mandy Wootton, Frank Sullivan

[link url="http://www.cardiff.ac.uk/news/view/649249-eczema-and-antibiotics"]Cardiff University material[/link]
[link url="http://www.annfammed.org/content/15/2/124"]The Annals of Family Medicine abstract[/link]

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