Antibiotic guidance issued for infected eczema

NICE says oral antibiotics should be offered to patients with secondary bacterial infection of eczema if they are systemically unwell.

Oral and topical antibiotics are not recommended for routine prescribing in people who are not systemically unwell, as the benefits are limited and there is a risk of contributing to antimicrobial resistance. Prescribers considering antibiotics in this setting should assess factors such as the extent and severity of infection and the risk of complications to determine whether such treatment is justified.

If antibiotic treatment is indicated for infected eczema, the recommended first choices for topical and oral treatment respectively are fusidic acid 2% (applied three times daily for 5–7 days) and flucloxacillin (500mg four times daily for 5–7 days in adults).

Clarithromycin (250mg twice daily for 5–7 days in adults) is the suggested alternative oral antibiotic if the patient has penicillin allergy. If the patient is pregnant, erythromycin (250–500mg four times daily for 5–7 days in adults) is recommended.

NICE found no evidence on the use of antibiotics to manage secondary bacterial infections of other common skin conditions such as psoriasis, chicken pox, shingles or scabies. Specialist advice may be needed in these cases.

NICE has previously issued separate guidance on antimicrobial prescribing for cellulitis and erysipelas. All antimicrobial regimens recommended by NICE in adults are summarised for quick reference in the MIMS antibiotics table.