A Cochrane review included 21 studies with a total of 1 018 subjects. The patients were both children and adults, males and females. Examined treatments covered oral antibiotics (3 trials), antibacterial soaps (1 trial), topical steroids combined with antibacterials (10 trials), antibacterial bath additives (2 trials), topical antiseptic/antibiotics creams (4 trials) and silver impregnated textiles (1 trial). Oral antibiotics were not associated with benefit in non-infected (2 trials, 66 participants) or infected eczema (1 trial, 33 participants). No benefit was found for antibacterial soaps (1 trial, 50 participants), or antibacterial bath additives (2 trials, 41 participants), or topical antibiotics/antiseptics (4 studies, 95 participants). Adding antibiotics to topical corticosteroids reduced numbers of Staphylococcus aureus in 4 trials (302 participants), but there was no evidence of any clinical benefit in 9 trials involving 677 participants: betamethasone plus neomycin vs clobetasol (MD 1.2; 95% CI 0.25 to 2.15), prednicarbate plus antimicrobial vs prednicarbate (RR 0.64; 95% CI 0.25 to 1.68), or betamethasone valerate plus gentamicin vs betamethasone (RR 0.31; 95% CI 0.07 to 1.35). One trial (30 participants) showed no significant improvement in eczema for those using silver textiles (RR 2.67; 95% CI 0.98 to 7.22), despite using 10 times the amount of topical steroids.
Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in interventions and outcomes) and study quality (e.g. inadequate or unclear allocation concealment and inadequate intention-to-treat adherence).