Chapter 4. Anti-Infective Therapy
Systemic antibiotics are usually necessary to treat overtly infected atopic dermatitis. (PICTURE A) First or second generation cephalosporins (e.g. cephalexin 25-50 mg/kg divided twice daily) given for 7-10 days are usually effective. A semi-synthetic penicillin can also be used. Since erythromycin resistant organisms are common, both erythromycin and newer macrolides are of limited usefulness. Long-term maintenance antibiotic therapy should be avoided as it may predispose to colonization by methicillin-resistant organisms.
A topical antibiotic such as mupirocin (Bactroban) can be applied three times daily to affected areas for seven to ten days to treat localized areas of involvement. In addition, twice daily intranasal application of mupirocin for 5 days can reduce nasal carriage of S. aureus which in turn can result in improvement of atopic dermatitis. Use of topical neomycin is discouraged as neomycin is one of the most common allergens causing contact dermatitis.
Patients with eczema herpeticum, also referred to as Kaposi's varicelliform eruption usually require treatment with systemic acyclovir in a hospital setting. Superficial dermatophytosis and P. ovale can be treated with topical or rarely systemic antifungal drugs. A subset of patients with atopic dermatitis may respond to treatment with antifungal agents.