Eczema - Antibiotic Prescribing

Comments from Expert Advisory Committee

Using antibiotics, or adding them to steroids, in eczema encourages resistance and does not improve healing unless there are visible signs of infection. In infected eczema, use treatment as in impetigo.

We recommend patients use the website developed by HSE/ICGP/IPU partnership for tips on how to get better from common infections without using antibiotics, what you can do for yourself or a loved one and when to seek help.

Infected Eczema

  • Swelling and crust (golden) suggest probable staphylococcal infection.
  • Swabs are not indicated unless treatment failure or atypical species suspected.
  • Restoring the barrier with appropriate topical steroids and emollients may reduce bacterial superinfection and lessen anti-microbial requirements.

Eczema Herpeticum

  • Is a dermatological emergency, warranting same day referral or contact with your local Dermatology department. Treatment is with aciclovir.

Bleach Baths

  • May reduce the bacterial load on the skin and contribute to reduced numbers of flares. It is recommended as a maintenance antimicrobial measure once or twice a week. During infective flares it may cause stinging.
  • Commercially available steriliser such as Milton.

Bleach bath recipe:

  • Sodium hypochlorite 6% solution diluted in bathwater.
  • e.g. 60mls in 1/4 filled bath.
  • 120mls in a 1/2 filled bath.
  • Equivalent to 2mls sodium hypochlorite/Litre water.

Spray for households without a bath.

Topical antibiotics should be used for a limited period < 2 weeks because of bacterial resistance.
They should not be co-prescribed with oral antibiotics for the same reason.

Oral antibiotics

See guidance on dosing in children for quick reference dosage/weight guide.

Dose Duration
Children Flucloxacillin  or
clarithromycin for penicillin allergic.
by weight under 12 as per child dosing table
Adults Flucloxacillin 500mgs qds 7-14 days

Penicillin allergic: clarithromycin

500mgs bd

7-14 days


  • Lewis-Jones, Mugglestone MA. Management of atopic eczema in children up to age 12 years : summary of NICE guidance. Guideline development group. 2007;335:1263-1264.
  • Barnes T, Greive KA.Use of bleach baths for the treatment of infected eczema. Australasian journal of dermatology. Review article.2013;54(4)251-258.
  • Eichenfield LF, Totri C. Optimising outcomes for paediatric atopic dermatitis. Review article. BJD 2014; 170:31-37.
  • Huang J,Abrams M, Tlougan B et al. Treatment of staphylococcus aureus colonisation in atopic dermatitis decreases disease severity. Paediatrics. 2009;123:808-14.

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Reviewed June 2016