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Evidence summaries

Interventions to Reduce Staphylococcus Aureus in the Management of Atopic Eczema

There is insufficient evidence on the effects of anti-staphylococcal treatments for treating people with infected or uninfected eczema. Topical steroid/antibiotic combinations may be associated with possible small improvements in good or excellent signs/symptoms compared with topical steroid alone. Level of evidence: "D"

The quality of evidence is downgraded by inconsistency (heterogeneity in interventions and outcomes) and study quality (e.g. inadequate or unclear allocation concealment and inadequate intention-to-treat adherence).

Summary

A Cochrane review [Abstract] 1 included 41 studies with a total of 1753 subjects. The patients were both children and adults, males and females.

Fourteen studies evaluated topical steroid/antibiotic combinations compared to topical steroids alone. Topical steroid/antibiotic combinations may lead to slightly greater global improvement in good or excellent signs/symptoms than topical steroid alone at 6 to 28 days follow-up (RR 1.10, 95% CI 1.00 to 1.21; 224 participants; 3 studies).

Four studies evaluated oral antibiotics compared to placebo. Oral antibiotics may make no difference in terms of good or excellent global improvement in infants and children at 14 to 28 days follow-up compared to placebo (RR 0.80; 95% CI 0.18 to 3.50; 75 participants; 2 studies).

Of five studies evaluating bleach baths compared to placebo (water) or bath emollient, one reported global improvement and showed that bleach baths may make no difference when compared with placebo at one month follow-up (RR 0.78, 95% CI 0.37 to 1.63; 36 participants.

    References

    • George SM, Karanovic S, Harrison DA et al. Interventions to reduce Staphylococcus aureus in the management of eczema. Cochrane Database Syst Rev 2019;(10):CD003871. [PubMed]

Primary/Secondary Keywords