13.10 Anti-infective skin preparations
- See Chapter 5 for guidance on the management of:
- athletes foot
- fungal skin and nail infections
Bacterial Infection in eczema
- Refer to NICE NG190 for management of secondary bacterial infection of eczema and other common skin conditions. In people who are not systemically unwell, do not routinely offer either a topical or oral antibiotic for secondary bacterial infection of eczema.
- Oral antibiotics are often necessary in moderate to severe infection or if the infection is recurrent or widespread:
- a 7 day course should be given
- flucloxacillin orally is usually the most appropriate for treating staphylococcus aureus
- erythromycin (or clarithromycin if erythromycin not tolerated) can be used if there is a penicillin allergy
- phenoxymethylpenicillin and flucloxacillin should be given if beta haemolytic streptococci are isolated or suspected on clinical evaluation
- If there are localized areas of infection, consider prescribing a topical antibiotic. Steroid- antibiotic combinations should be used in short courses (typically 1 week) to reduce the risk of drug resistance or skin sensitisation.
- Swabs for bacteriology are particularly useful if patients do not respond to treatment, in order to identify antibiotic resistant strains of S. aureus or to detect additional streptococcal infectionb
- General measures to prevent infection:
- avoid long-term use of topical antibiotics such as fusidic acid which leads to bacterial resistance
- avoid contamination of topical agents
- tubs of ointment should not be left open
- simple clean procedures should be used by patients or carers applying the creams, e.g. using clean spoons to remove cream from the jar.
- pump dispensers may also be useful