| Since the dawn of the internet, obtaining information has become progressively more convenient. With this convenience, we must exercise caution, as claims and medical advise abound. ITSAN strives to provide clear information from scholarly material on topics relevant within the dermatology community.
Topical steroids and antibiotics are two of the most impacting discoveries in medical history. Used with care and wise time frames, they can be effective. However, using for extended periods of time, often presents undesired consequences.
Here is a brief history of topical steroids. "Corticosteroids are synthetic relatives of the hormones produced by the adrenal glands, such as cortisone. Since the mid-1950s, there have been numerous modifications of the corticosteroid molecule that have dramatically increased the potency of this topical therapy (i.e., halogenation, esterification, hydroxylation, modification of side chains, and improvements in delivery systems). As the potency of the molecule has increased, so has the likelihood of side effects."
https://clinicalgate.com/topical-steroids/
https://www.nps.org.au/australian-prescriber/articles/the-role-of-corticosteroids-in-dermatology The amazing discovery of antibiotics can be traced way back to the early world. "The traces of tetracycline, for example, have been found in human skeletal remains from ancient Sudanese Nubia dating back to 350–550 AD." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3109405/
Andrew Fleming discovered the first true antibiotic, penicillin, on September 3, 1928. He noticed his one of his petri dishes containing staphylococcus bacteria, had mold and that particular area was clear. From there, a whole new door opened to the world of antibiotics that would save thousands of lives and restore health to multitudes.
https://www.acs.org/content/acs/en/education/whatischemistry/landmarks/flemingpenicillin.html
The combining of antibiotics with topical steroids has been practiced and believed to be an effective way to control serious eczema flares due to the Staphylococcus aureus bacteria exacerbating the condition. However, this has been controversial in the medical community as these conflicting studies show.
1976-"No side-effects occurred with any drug combination use. In the opinion of the authors halcinonide-neomycin-amphotericin cream and ointment are safe and effective in the treatment of cutaneous candiasis and steroid-responsive dermatoses."
https://www.ncbi.nlm.nih.gov/pubmed/799995
2000-"Topical antibacterial-corticosteroid combinations can be useful when treating small areas of skin for a limited period of time but are accompanied by the risk of sensitization and the emergence of resistant strains of bacteria. Systemic antibacterials in combination with topical corticosteroid are more appropriate when larger areas are involved."
https://link.springer.com/article/10.2165/00128071-200001040-00002
2008-"Eczema of all types frequently becomes infected with S. aureus, and infection may exacerbate the eczema, making it less responsive to topical corticosteroids. The short-term use of a fusidic acid corticosteroid combination preparation effectively controls infection without risk of drug resistance developing. In the author's clinic, all patients referred with eczema are treated with daily baths, emollients, moisturizers and cyclical 2-week treatments with a fusidic acid/corticosteroid preparation of suitable strength alternating with corticosteroid alone. Where xerosis is a particular problem, the new formulation of fusidic acid/betamethasone in a lipid cream would be indicated."
http://file:///home/chronos/u-274081b779074301fb0d2ecc8f9c368792659eca/Downloads/8821628%20(2).pdf
2016-"Our data suggest that oral and topical antibiotics have no effect, or a harmful effect, on subjective eczema severity in children with clinically infected eczema in the community."
https://www.ncbi.nlm.nih.gov/pubmed/26938214
2017-"We found rapid resolution in response to topical steroid and emollient treatment and ruled out a clinically meaningful benefit from the addition of either oral or topical antibiotics. Children seen in ambulatory care with mild clinically infected eczema do not need treatment with antibiotics."
https://www.ncbi.nlm.nih.gov/pubmed/28289111
2017-"There were no statistically significant differences in treatment response (i.e., proportion of patients who had improvement in symptoms or signs) between topical antibiotics (i.e., fusidic acid, mupirocin, gentamycin, retapamulin) plus corticosteroids (i.e., hydrocortisone, betamethasone, clobetasone) and corticosteroids alone at the end of treatment. One RCT (Randomiized Controlled Trials) found that there was no difference in the cure rate between two different combinations of topical antibiotics and steroids (i.e., fusidic acid plus halomethasone versus neomycin plus betamethasone). One RCT included in the SR (Systemic Review) showed that the combination of neomycin and betamethasone was even inferior to clobetasol. The combination of topical steroid, antibiotic and antifungal (i.e., halcinonide, neomycin and nystatin) also showed no significant difference for the improvement in symptoms of eczema rated by patients or medical practitioners compared with topical steroid (i.e.,hydrocortisone)."
https://www.cadth.ca/sites/default/files/pdf/htis/2017/RC0852_Topical%20Antibiotics%20for%20Infected%20Dermatitis%20Final.pdf
This Mayo Clinic study reveals a risk of increased amounts of staph by using topical steroids.
"Glucocorticoid use was associated with a substantially increased risk of CA-SAB. The risk increased with higher cumulative dose, revealing a distinct dose-response relation."
http://www.mayoclinicproceedings.org/article/S0025-6196%2816%2930145-8/fulltext
How long to use antibiotic/topical steroid combos?
NICE (National Healthcare for Excellence) recommends that topical antibiotics, including those in combination with topical steroids, should only be used for short periods (less than 14 days) in cases of clinically infected eczema. However, there is no clear evidence that the addition of antibiotics to topical corticosteroids offers any advantage over topical corticosteroids alone, and they are not recommended in noninfected eczema."
http://onlinelibrary.wiley.com/doi/10.1002/psb.1428/pdf
The widespread and highly publicized threat of "super bugs" due to multiple uses of antibiotics ranging from health issues to food producing livestock, demands that the medical community find alternative ways to decolonize bacteria. This has become a major quest for the World Health Organization (WHO).
http://www.who.int/mediacentre/news/releases/2017/bacteria-antibiotics-needed/en/
"Antibiotics are among the most commonly prescribed drugs used in human medicine and can be lifesaving drugs. However, up to 50% of the time antibiotics are not optimally prescribed, often done so when not needed, incorrect dosing or duration."
https://www.cdc.gov/drugresistance/about.html
"Bacteria have been part of the normal human microflora for eons and usually do not cause signs or symptoms of infection. This colonization is most common in body sites such as the nose, skin, and gastrointestinal tract. The body sites of colonization are usually specific to the type of bacteria.
The Centers for Disease Control and Prevention (CDC) report "Antibiotic Resistance Threats in the United States, 2013" highlights that at least two million Americans acquire severe antibiotic-resistant infections each year, which results in 23,000 deaths annually. Most deaths occur in health care settings such as hospitals. That CDC report recommends attempting to prevent these infections through appropriate antibiotic use and infection prevention practices. Healthcare Associated Infections (HAI) are now the fifth leading cause of death in U.S. acute-care hospitals."
http://cmr.asm.org/content/29/2/201.full
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