Antibiotics not effective for clinically infected eczema in children

Estimates suggest that 40 percent of eczema flares are treated with topical antibiotics, but findings from a study led by Cardiff University 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 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 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 practicing 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."

How bacteria survive antibiotic treatment

Multiresistant bacteria Scientists around the world are working hard to win the battle against multi-resistant bacteria. A new publication from the BASP Centre, University of Copenhagen now presents how even sensitive bacteria often manage to survive antibiotic treatment as so-called 'persister cells'. The comprehensive perspective on this phenomenon may help to improve current options of drug treatment and could even inspire the discovery of novel antibiotics targeting these notoriously difficult-to-treat persister bacteria.

In the current issue of the journal Science, Alexander Harms and colleagues from the BASP Centre, Department of Biology, University of Copenhagen summarise newly discovered molecular mechanisms explaining how bacteria manage to survive antibiotic treatment and cause chronic and recurrent infections.

Post-Doc Alexander Harms explains: "This amazing resilience is often due to hibernation in a physiological state called persistence where the bacteria are tolerant to multiple antibiotics and other stressors. Bacterial cells can switch into persistence by activating dedicated physiological programs that literally pull the plug of important cellular processes. Once they are persisters, the bacteria may sit through even long-lasting antibiotic therapy and can resuscitate to cause relapsing infections at any time after the treatment is abandoned."

Using novel detection methods, recent work in the field has uncovered the molecular architecture of several cellular pathways underlying the formation of bacterial persisters -- and these results confirmed the long-standing notion that persistence is intimately connected to slow growth or dormancy. Bacterial persistence can therefore be compared to hibernation of animals or the durable spores produced by many mushrooms and plants.

Across many different bacteria, these programs are controlled by a regulatory compound known as "magic spot" that plays a central role in the persistence phenomenon. These important discoveries, many of which were accomplished by the BASP Centre, may in the future facilitate the development of improved drug treatment regimens and eventually lead to the development of novel antibiotics.


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