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 or topical antibiotics in addition to topical emollient and corticosteroid in children with clinically infected eczema.Methods: Three arm, blinded randomized controlled trial in UK ambulatory care. Children with clinical non-severely infected eczema were randomized to receive oral and topical placebos (CTRL), oral antibiotic (flucloxacillin) and topical placebo (OA), or topical fusidic acid and oral placebo (TA), for 1 week. We compared Patient Oriented Eczema Measure (POEM) scores at two weeks using ANCOVA.Results: 113 children (40 CTRL, 36 OA, 37 TA) were randomized. Mean (SD) baseline POEM scores were, CTRL:13·4(5·1), OA:14·6(5·3) and TA:16·9(5·5). 104 (93%) had one or more of weeping, crusting, pustules or painful skin at baseline. Mean (SD) POEM scores at two-weeks were, CTRL:6·2(6·0), OA:8·3(7·3), and TA:9·3(6·2). Controlling for baseline POEM, OA and TA resulted in a no significant difference in mean (95% confidence interval) 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