Comparison of bleach, acetic acid, and other topical anti-infective treatments in pediatric atopic dermatitis: A retrospective cohort study on antibiotic exposure

Sarah Asch, Diana L. Vork, Josiane Joseph, Brittny Major-Elechi, Megha M Tollefson

Research output: Contribution to journalArticle

Abstract

Background/Objectives: 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: 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: 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: 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.

Original languageEnglish (US)
Pages (from-to)115-120
Number of pages6
JournalPediatric Dermatology
Volume36
Issue number1
DOIs
StatePublished - Jan 1 2019

Fingerprint

Atopic Dermatitis
Acetic Acid
Cohort Studies
Retrospective Studies
Pediatrics
Anti-Bacterial Agents
Superinfection
Baths
Therapeutics
Dermatology
Ambulatory Care Facilities
Tertiary Care Centers
Skin
Infection

Keywords

  • atopic dermatitis
  • bacterial
  • eczema
  • infection
  • therapy
  • topical

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Dermatology

Cite this

Comparison of bleach, acetic acid, and other topical anti-infective treatments in pediatric atopic dermatitis : A retrospective cohort study on antibiotic exposure. / Asch, Sarah; Vork, Diana L.; Joseph, Josiane; Major-Elechi, Brittny; Tollefson, Megha M.

In: Pediatric Dermatology, Vol. 36, No. 1, 01.01.2019, p. 115-120.

Research output: Contribution to journalArticle

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abstract = "Background/Objectives: 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: 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: 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: 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.",
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