13.10 Anti-infective skin preparations

General Notes

  • See Chapter 5 for guidance on the management of:
    • abscesses/boils
    • cellulitis/impetigo
    • bites
    • athletes foot
    • fungal skin and nail infections

Bacterial Infection in 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