A randomised placebo-controlled trial of oral and topical antibiotics for children with clinically infected eczema in the community: The ChildRen with eczema, antibiotic management (CREAM) study

Francis, Nick A; Ridd, Matthew J; Thomas-Jones, Emma; Shepherd, Victoria; Butler, Christopher C; Hood, Kerenza; Huang, Chao; Addison, Katy; Longo, Mirella; Marwick, Charis; Wootton, Mandy; Howe, Robin; Roberts, Amanda; Haq, Mohammed Inaam-ul; Madhok, Vishnu; Sullivan, Frank; on behalf of the CREAM team

Abstract

Background
Secondary skin infection is common during eczema exacerbations and many children are treated with antibiotics when this is suspected, although there is little high-quality evidence to justify this practice.

Objective
To determine the clinical effectiveness of oral and topical antibiotics, in addition to standard treatment with emollients and topical corticosteroids, in children with clinically infected eczema.

Conclusions
Our data suggest that oral and topical antibiotics have no effect, or a harmful effect, on subjective eczema severity in children with clinically infected eczema in the community. The CIs around our estimates exclude a meaningful beneficial effect (published minimal clinically important difference for POEM is 3.4). Although most patients in this trial had features suggestive of infection and S. aureus on their skin, participants primarily had mild–moderate eczema and those with signs of more severe infection were often excluded. Clinicians should consider avoiding oral and topical antibiotic use in children with suspected infected eczema in the community who do not have signs of ‘severe infection’. Further research should seek to understand how best to encourage the use of topical steroids and limit use of antibiotics in those with eczema flares without signs of severe infection, as well as developing tools to better phenotype eczema flares, in order to better define a population that may benefit from antibiotic treatment.

Citation

Francis, N. A., Ridd, M. J., Thomas-Jones, E., Shepherd, V., Butler, C. C., Hood, K., Huang, C., Addison, K., Longo, M., Marwick, C., Wootton, M., Howe, R., Roberts, A., Haq, M. I.-U., Madhok, V., Sullivan, F., & on behalf of the CREAM team. (2016). A randomised placebo-controlled trial of oral and topical antibiotics for children with clinically infected eczema in the community: The ChildRen with eczema, antibiotic management (CREAM) study. Health Technology Assessment, 20(19), 1-84. https://doi.org/10.3310/hta20190

• Journal Article Type: Article
• Acceptance Date: Nov 1, 2015
• Publication Date: 2016-03
• Deposit Date: Jul 30, 2019
• Publicly Available Date: Jul 30, 2019
• Journal: Health Technology Assessment
• Print ISSN: 1366-5278
• Publisher: NIHR Journals Library
• Peer Reviewed: Peer Reviewed
• Volume: 20
• Issue: 19
• Pages: 1-84
• DOI: https://doi.org/10.3310/hta20190
• Public URL: https://hull-repository.worktribe.com/output/2019948
• Publisher URL: https://www.journalslibrary.nihr.ac.uk/hta/hta20190/#/full-report
• Contract Date: Jul 30, 2019