Oral and topical antibiotics

There are many different types of treatments for eczema, however for more severe cases where there is a high risk of infection, such as when the skin cracks, blisters and/or bleeds, your doctor/dermatologist may suggest topical or oral antibiotics.

Infected eczema looks red and angry and is usually weepy with a yellowish crust and clear or yellow fluid. Pustules and small red spots may be present. The skin feels hot, itchy and sore and your eczema is likely to worsen. An infection may also show through a raised temperature, flu-like symptoms or swollen glands in the armpit, neck and groin. Antibiotics may be used to treat bacterial infections that:

  • are unlikely to clear up without antibiotics
  • could infect others unless treated
  • could take too long to clear without treatment
  • carry a risk of more serious complication

Using oral antibiotics is often necessary in moderate to severe cases of skin infection or if the infection is recurrent or widespread. Usually a 7-day course is given. Bacteria, fungus and virus can cause infection in eczema and some of the different types of infection are: A bacteria called Staphylococcus Aureus, which thrives on weepy and broken skin, is very common in eczema. This bacteria is found on the skin of virtually everyone with atopic eczema, even when there are no signs of infection. Infection with Staphylococcus Aureus makes eczema worse, hinders healing and multiplies as the eczema becomes more severe.

  • Fungal infections are common in everyone, but people with eczema may be more vulnerable. Candida (also known as thrush) is a yeast infection that often develops in warm moist skin folds.
  • Tinea (alos known as ringworm) can be found all over the body, often as isolated patches, or in-between the toes (also known as athlete’s foot)
  • Herpes simplex, the cold sore virus, can cause severe infection (known as eczema herpeticum) in anyone with eczema due to a lower resistance to the virus. For this reason it is advisable to avoid contact with anyone who has a cold soreIf the infected area is quite significant your doctor/dermatologist will be keen to start you on a treatment of oral antibiotics almost immediately.

Either oral antibiotics or topical antibiotics may be used. Oral antibiotics are tablets, pills, capsules or a liquid that you take by mouth. Topical antibiotics are creams, lotions, sprays or drops which are applied to the skin or in the case of drops into the eyes.

If there are extensive areas of infected eczema, the skin is generally swabbed then an oral antibiotic which has been prescribed by your doctor. Routine swabbing of skin that is not infected isnotrecommended.

The recommended oral antibiotics from one month of age onwards are (NICE guidance, 2015):

  • Flucloxacillin is the first-line choice. Flucloxacillin is part of the Penicillin family of antibiotics.
  • Erythromycin is prescribed if the person has an allergy to penicillin or if there is known resistance to Flucloxacillin. If the person has previously been unable to tolerate Erythromycin because of nausea or cramps, Clarithromycin may be considered.

If the infection responds poorly to antibiotic treatment, an alternative antibiotic may be considered if necessary. If it does not respond well to the above advice, specialist help may be advised.

Topical antibiotics are generally prescribed if there are localised (smaller) areas of infection. Creams or ointments containing antibiotics can be used as separate products or combined with a steroid cream. Topical antibiotics should be used for no longer than 2 weeks.

  • Fungal infection – usually antifungal creams and ointments (may be combined with topical steroids).
  • Viral infection – antiviral tablets or, if very severe and admission to hospital is required, drugs given via a drip.

As with all courses of medicine, it's essential to finish taking a prescribed course of antibiotics, even if you feel better, unless a healthcare professional tells you otherwise. If you stop taking an antibiotic part way through a course, the bacteria can become resistant to the antibiotic. If you forget to take a dose of your antibiotics, take that dose as soon as you remember and then continue to take your course of antibiotics as normal. Butif it's almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Don't take a double dose to make up for a missed one as there may  be an increased risk of side effects if you take two doses closer together than recommended.

Your doctor/dermatologist will provide you with a treatment programme relevant to your symptoms.

Sources used in writing this article are available on request

Information contained in this Articles page has been written by talkhealth based on available medical evidence. Our evidence-based articles are certified by the Information Standard and our sources are available on request. The content is not, though, written by medical professionals and should never be considered a substitute for medical advice. You should always seek medical advice before changing your treatment routine. talkhealth does not endorse any specific products, brands, or treatments.

Information written by the talkhealth team

Next review: 21 June 2022