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Antibiotics not effective for clinically infected eczema in children

Dr Matthew Ridd, University of Bristol

14 March 2017

Estimates suggest that 40 percent of eczema flares are treated with topical antibiotics but findings from a study involving academics from the University of Bristol’s Centre for Academic Primary Care suggest there is no meaningful benefit from the use of either oral or topical antibiotics for milder clinically infected eczema in children.

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, led by Cardiff University, 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 published today in the Annals of Family Medicine journal, 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 practising GP, who led the study said:

“Topical antibiotics, often in combination products with topical corticosteroids, are frequently used to treat eczema flares. Our research shows that even if there are signs of infection, children with milder eczema are unlikely to benefit from antibiotics, and their use can promote resistance and allergy or skin sensitization”.

“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.”

Dr Matthew Ridd, GP and lead researcher at the University of Bristol, said:

“This study provides further evidence to support the appropriate use of topical corticosteroids to treat flares in children with eczema and to minimise the use of the precious resource of antibiotics.”

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 full results publication can be viewed online at:

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

Publication citation:

‘Oral and Topical Antibiotics for Clinically Infected Eczema in Children: A Pragmatic Randomized Controlled Trial in Ambulatory Care’. Francis NA, Ridd MJ, Thomas-Jones E, Butler CC, Hood K, Shepherd V, Marwick CA, Huang C, Longo M, Wootton M, Sullivan F, the CREAM Trial Management Group. Ann Fam Med 2017;15:124-130.

Further information

Related Links

Summaries for parents and GPs are available from the Centre for Trials Research

CREAM study website:

Centre for Academic Primary Care, University of Bristol

Eczema-related research studies: 

COMET – Choice of moisturiser in eczema treatment

APACHE – Action plans for children with eczema

BEEP – Barrier enhancement for eczema protection

BATHE – Bath additives in the treatment of childhood eczema

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