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Oral and topical antibiotics for clinically infected eczema in children: a pragmatic randomized controlled trial in ambulatory care

Oral and topical antibiotics for clinically infected eczema in children: a pragmatic randomized controlled trial in ambulatory care
Oral and topical antibiotics for clinically infected eczema in children: a pragmatic randomized controlled trial in ambulatory care
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.
eczema infection anti-bacterial agents
1544-1709
124-130
Francis, Nicholas A.
9b610883-605c-4fee-871d-defaa86ccf8e
Ridd, Matthew J.
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Thomas-Jones, Emma
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Butler, Christopher C.
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Hood, Kerenza
af7cf839-ca85-4ea9-83c3-3dd31be88b32
Shepherd, Victoria
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Marwick, Charis A.
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Huang, Chao
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Longo, Mirella
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Wootton, Mandy
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Sullivan, Frank
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Francis, Nicholas A.
9b610883-605c-4fee-871d-defaa86ccf8e
Ridd, Matthew J.
de8b7ad0-5afa-4231-99f6-d6778744ddd4
Thomas-Jones, Emma
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Butler, Christopher C.
8bf4cace-c34a-4b65-838f-29c2be91e434
Hood, Kerenza
af7cf839-ca85-4ea9-83c3-3dd31be88b32
Shepherd, Victoria
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Marwick, Charis A.
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Huang, Chao
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Longo, Mirella
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Wootton, Mandy
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Sullivan, Frank
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Francis, Nicholas A., Ridd, Matthew J., Thomas-Jones, Emma, Butler, Christopher C., Hood, Kerenza, Shepherd, Victoria, Marwick, Charis A., Huang, Chao, Longo, Mirella, Wootton, Mandy and Sullivan, Frank (2017) Oral and topical antibiotics for clinically infected eczema in children: a pragmatic randomized controlled trial in ambulatory care. Annals of Family Medicine, 15 (2), 124-130. (doi:10.1370/afm.2038).

Record type: Article

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.

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More information

Accepted/In Press date: 20 November 2016
e-pub ahead of print date: March 2017
Published date: March 2017
Keywords: eczema infection anti-bacterial agents

Identifiers

Local EPrints ID: 436137
URI: http://eprints.soton.ac.uk/id/eprint/436137
ISSN: 1544-1709
PURE UUID: 45455f9f-c5a3-42b5-99ee-28d9014c6355
ORCID for Nicholas A. Francis: ORCID iD orcid.org/0000-0001-8939-7312

Catalogue record

Date deposited: 29 Nov 2019 17:30
Last modified: 09 Jan 2022 04:08

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Contributors

Author: Matthew J. Ridd
Author: Emma Thomas-Jones
Author: Christopher C. Butler
Author: Kerenza Hood
Author: Victoria Shepherd
Author: Charis A. Marwick
Author: Chao Huang
Author: Mirella Longo
Author: Mandy Wootton
Author: Frank Sullivan

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