Comparison of bleach, acetic acid, and other topical anti-infective treatments in pediatric atopic dermatitis: A retrospective cohort study on antibiotic exposure.
Acetic Acid
/ administration & dosage
Adolescent
Anti-Bacterial Agents
/ administration & dosage
Anti-Infective Agents, Local
/ administration & dosage
Child
Child, Preschool
Cohort Studies
Dermatitis, Atopic
/ complications
Female
Humans
Infant
Male
Practice Guidelines as Topic
Retrospective Studies
Skin
/ microbiology
Skin Diseases, Bacterial
/ epidemiology
Sodium Hypochlorite
/ administration & dosage
atopic dermatitis
bacterial
eczema
infection
therapy
topical
Journal
Pediatric dermatology
ISSN: 1525-1470
Titre abrégé: Pediatr Dermatol
Pays: United States
ID NLM: 8406799
Informations de publication
Date de publication:
Jan 2019
Jan 2019
Historique:
pubmed:
12
10
2018
medline:
9
2
2019
entrez:
11
10
2018
Statut:
ppublish
Résumé
Skin infection is common in atopic dermatitis (AD), often necessitating treatment with systemic antibiotics. Topical adjunctive therapies such as dilute bleach baths are increasingly recommended, and topical dilute acetic acid (AA) has not been widely studied. The objective of this study was to evaluate whether various topical anti-infective bathing recommendations were associated with decreased systemic antibiotic exposure in pediatric AD, as well as evaluate topical anti-infective recommendations over time within our institution. Clinical data were extracted from charts of pediatric patients from 1/1/2000 to 12/31/2005 and 1/1/2009 to 12/31/2014 who visited outpatient dermatology clinics at Mayo Clinic, Rochester, a tertiary referral center. Recommendations for topical anti-infectives (dilute AA, dilute bleach, other, or none) at any time after patient had clinically proven or suspected AD superinfection were recorded as exposures to topical anti-infective. Primary outcome was the number of systemic antibiotic courses in a 1-year period. Of 1111 patients with AD, 753 met inclusion criteria (303 in 2000-2005; 450 in 2009-2014). Of these, 351 (46.6%) had culture-proven or clinically suspected superinfection. Topical anti-infective recommendations increased between the time periods (23.3% to 79.2%; P < 0.001) and number of courses of systemic antibiotics decreased (1.9 per year vs 1.5 per year, P = 0.010). Number of systemic antibiotic courses did not differ between those who received bathing recommendations and those who did not, nor between different anti-infective groups (P = 0.398). Practice behaviors have changed, and topical anti-infectives are now commonly recommended. Neither dilute AA nor bleach baths were associated with fewer subsequent exposures to systemic antibiotics in the treatment of pediatric AD.
Sections du résumé
BACKGROUND/OBJECTIVES
OBJECTIVE
Skin infection is common in atopic dermatitis (AD), often necessitating treatment with systemic antibiotics. Topical adjunctive therapies such as dilute bleach baths are increasingly recommended, and topical dilute acetic acid (AA) has not been widely studied. The objective of this study was to evaluate whether various topical anti-infective bathing recommendations were associated with decreased systemic antibiotic exposure in pediatric AD, as well as evaluate topical anti-infective recommendations over time within our institution.
METHODS
METHODS
Clinical data were extracted from charts of pediatric patients from 1/1/2000 to 12/31/2005 and 1/1/2009 to 12/31/2014 who visited outpatient dermatology clinics at Mayo Clinic, Rochester, a tertiary referral center. Recommendations for topical anti-infectives (dilute AA, dilute bleach, other, or none) at any time after patient had clinically proven or suspected AD superinfection were recorded as exposures to topical anti-infective. Primary outcome was the number of systemic antibiotic courses in a 1-year period.
RESULTS
RESULTS
Of 1111 patients with AD, 753 met inclusion criteria (303 in 2000-2005; 450 in 2009-2014). Of these, 351 (46.6%) had culture-proven or clinically suspected superinfection. Topical anti-infective recommendations increased between the time periods (23.3% to 79.2%; P < 0.001) and number of courses of systemic antibiotics decreased (1.9 per year vs 1.5 per year, P = 0.010). Number of systemic antibiotic courses did not differ between those who received bathing recommendations and those who did not, nor between different anti-infective groups (P = 0.398).
CONCLUSIONS
CONCLUSIONS
Practice behaviors have changed, and topical anti-infectives are now commonly recommended. Neither dilute AA nor bleach baths were associated with fewer subsequent exposures to systemic antibiotics in the treatment of pediatric AD.
Substances chimiques
Anti-Bacterial Agents
0
Anti-Infective Agents, Local
0
Sodium Hypochlorite
DY38VHM5OD
Acetic Acid
Q40Q9N063P
Types de publication
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
115-120Subventions
Organisme : Dermatology Foundation
Informations de copyright
© 2018 Wiley Periodicals, Inc.