Mostafa Elsersy The use of topical antibiotics in the management of topical antibiotics is not mentioned in the standard treatment guidelines on atopic dermatitis in my area of practice. However as a physician if I suspect that the site of dermatitis is infected I would take a swab and send for microscopy culture and sensitivity (mcs).If the patient is septic , I would use broad spectrum antibitics and give intravenously while awaiting samples of mcs which would have been taken prior to start of antibiotics. Due to the increasing risk of antibiotic resistance I don't use antibiotics for more than two weeks or beyond the specified time.

My practice is topical antibiotics (mupirocin, fusidinic acid) for 10-14 days if the smaller area of atopic dermatitis is complicated with infection, mostly with Staph. aureus. Larger area with symptoms of systemic inflammatiion, antibiotics per os or systemic (iv., im). In atopic dermatitis with often relapses of infection, it is recommended to use baths with Na hipoclorit (bleach baths).

Each exacerbation of AD can be associated with bacterial infection; staphylococcal infections are the most common. The skin of patients with AD is colonized with this pathogen in 90% of cases. Eradication of Staphylococcus aureus significantly reduces the severity of the disease ; however, due to increasing drug resistance and the defective antimicrobial peptide profile in AD, sustained decolonization of the skin is practically impossible. Studies indicate the efficacy of octenidine, chlorhexidine, mupirocin, fusidic acid and retapamulin. Due to the above-mentioned antibiotic resistance, chronic use of topical antibiotics is not recommended. The rationale for the use of oral antibiotics is exacerbation of AD with clinical signs of bacterial infection ; in other cases, treatment with oral antibiotics is not recommended .