| [PMID]: | 28289111 |
| [Au] Autor: | Francis NA; Ridd MJ; Thomas-Jones E; Butler CC; Hood K; Shepherd V; Marwick CA; Huang C; Longo M; Wootton M; Sullivan F; CREAM Trial Management Group |
| [Ad] Endereço: | Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, Wales francisna@cf.ac.uk. |
| [Ti] Título: | Oral and Topical Antibiotics for Clinically Infected Eczema in Children: A Pragmatic Randomized Controlled Trial in Ambulatory Care. |
| [So] Source: | Ann Fam Med;15(2):124-130, 2017 Mar. |
| [Is] ISSN: | 1544-1717 |
| [Cp] País de publicação: | United States |
| [La] Idioma: | eng |
| [Ab] Resumo: | 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. |
| [Mh] Termos MeSH primário: |
Antibacterianos/administração & dosagem
Eczema/tratamento farmacológico
Floxacilina/administração & dosagem
Ácido Fusídico/administração & dosagem
|
| [Mh] Termos MeSH secundário: |
Administração Cutânea
Administração Oral
Corticosteroides/administração & dosagem
Assistência Ambulatorial
Criança
Pré-Escolar
Feminino
Seres Humanos
Lactente
Masculino
Índice de Gravidade de Doença
Resultado do Tratamento
Reino Unido
|
| [Pt] Tipo de publicação: | JOURNAL ARTICLE; PRAGMATIC CLINICAL TRIAL |
[Nm] Nome de substância:
| 0 (Adrenal Cortex Hormones); 0 (Anti-Bacterial Agents); 43B2M34G2V (Floxacillin); 59XE10C19C (Fusidic Acid) |
| [Em] Mês de entrada: | 1711 |
| [Cu] Atualização por classe: | 171113 |
[Lr] Data última revisão:
| 171113 |
| [Sb] Subgrupo de revista: | IM |
| [Da] Data de entrada para processamento: | 170315 |
| [St] Status: | MEDLINE |
| [do] DOI: | 10.1370/afm.2038 |
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