Oral and Topical Antibiotics for Clinically Infected Eczema in Children: A Pragmatic Randomized Controlled Trial in Ambulatory Care

I am glad to see these results published. As a member of the Data Monitoring Committee I am aware how hard the team worked to get participants recruited into this trial. As a parent of children with eczema the result is of personal importance to me.

It's difficult to explain how the uncertainty about when antibiotics are needed has influenced my confidence in managing eczema. As a doctor-parent, it was challenging when I thought my child's eczema needed antibiotics but others didn't. And it was just as challenging when my child was an inpatient for another condition, a passing doctor insisted my child needed antibiotics for eczema when he looked his usual self to me.

Now I know that if eczema is mild or moderate then it doesn't need antibiotics.

Competing interests: member of the Data Monitoring Committee

We agree with Williams that this study provides evidence that infected eczema responds well to treatment of inflammation with topical corticosteroids, regardless of whether antibiotics are added. There is a need to address widely held fears about the use of appropriate potency topical corticosteroids, and to avoid the frequent use of combination topical antibiotic/corticosteroids, instead of topical corticosteroids alone, in the absence of clear indications (i.e. Clear signs of more severe infection, failure to respond to adequate potency corticosteroids and emollients).

Competing interests: None declared