Which medications in the drug class Antibiotics are used in the treatment of Atopic Dermatitis?

Answer

Antibiotics

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting. For the treatment of clinical infection by S aureus, cloxacillin or cephalexin is used. In streptococcal infections, cephalexin is preferred. If not effective, penicillin and clindamycin in combination are effective. Consider staphylococcal infection in every flare of atopic dermatitis.

Cephalexin (Keflex)

Cephalexin is a first-generation cephalosporin that arrests bacterial growth by inhibiting bacterial cell wall synthesis. It has bactericidal activity against rapidly growing organisms. Its primary activity is against skin flora; it is used for skin infections or prophylaxis in minor procedures.

Cephalexin suspension includes mauve granules (125 mg/5 mL) and peach granules (250 mg/5 mL).

Penicillin VK (Beepen-VK, Betapen-VK, Veetids)

Penicillin VK inhibits the biosynthesis of cell wall mucopeptide. It is bactericidal against sensitive organisms when adequate concentrations are reached, and it is most effective during the stage of active multiplication. Inadequate concentrations may produce only bacteriostatic effects.

Clindamycin (Cleocin)

Clindamycin is a lincosamide for the treatment of serious skin and soft tissue staphylococcal infections. It is also effective against aerobic and anaerobic streptococci (except enterococci). It inhibits bacterial growth, possibly by blocking the dissociation of peptidyl t-RNA from ribosomes, causing RNA-dependent protein synthesis to arrest.

Mupirocin (Bactroban, Bactroban Nasal, Centany)

Mupirocin is used as a topical treatment for bacterial skin infections such as furuncle, impetigo, and open wounds. It is also useful in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infection.

Trimethoprim/sulfamethoxazole (Bactrim, Bactrim DS, Cotrim)

Sulfamethoxazole disrupts bacterial folic acid synthesis and growth via inhibition of dihydrofolic acid formation; trimethoprim inhibits dihydrofolic acid reduction to tetrahydrofolate, resulting in the inhibition of enzymes of the folic acid pathway.

Did this answer your question?

Yes No

Additional feedback? (Optional)

Thank you for your feedback!

Spergel JM. From atopic dermatitis to asthma: the atopic march. Ann Allergy Asthma Immunol. 2010 Aug. 105(2):99-106; quiz 107-9, 117. [Medline].
Carlsten C, Dimich-Ward H, Ferguson A, Watson W, Rousseau R, Dybuncio A, et al. Atopic dermatitis in a high-risk cohort: natural history, associated allergic outcomes, and risk factors. Ann Allergy Asthma Immunol. 2013 Jan. 110(1):24-8. [Medline].
[Guideline] Eichenfield LF, Tom WL, Chamlin SL, Feldman SR, Hanifin JM, Simpson EL, et al. Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis. J Am Acad Dermatol. 2014 Feb. 70(2):338-51. [Medline].
Heller M, Shin HT, Orlow SJ, Schaffer JV. Mycophenolate mofetil for severe childhood atopic dermatitis: experience in 14 patients. Br J Dermatol. 2007 Jul. 157(1):127-32. [Medline].
Van Velsen SG, Haeck IM, Bruijnzeel-Koomen CA. Severe atopic dermatitis treated with everolimus. J Dermatolog Treat. 2009. 20(6):365-7. [Medline].
Feldman SR. Adherence must always be considered: is everolimus really ineffective as a treatment for atopic dermatitis?. J Dermatolog Treat. 2009. 20(6):317-8. [Medline].
Huang JT, Abrams M, Tlougan B, Rademaker A, Paller AS. Treatment of Staphylococcus aureus colonization in atopic dermatitis decreases disease severity. Pediatrics. 2009 May. 123(5):e808-14. [Medline].
Jansen CT, Haapalahti J, Hopsu-Havu VK. Immunoglobulin E in the human atopic skin. Arch Dermatol Forsch. 1973 May 28. 246(4):209-302. [Medline].
Koga C, Kabashima K, Shiraishi N, Kobayashi M, Tokura Y. Possible pathogenic role of Th17 cells for atopic dermatitis. J Invest Dermatol. 2008 Nov. 128 (11):2625-30. [Medline].
Molfino NA, Gossage D, Kolbeck R, Parker JM, Geba GP. Molecular and clinical rationale for therapeutic targeting of interleukin-5 and its receptor. Clin Exp Allergy. 2011 Sep 23. [Medline].
Hershko AY, Suzuki R, Charles N, Alvarez-Errico D, Sargent JL, Laurence A, et al. Mast cell interleukin-2 production contributes to suppression of chronic allergic dermatitis. Immunity. 2011 Oct 28. 35 (4):562-71. [Medline].
Kim BS, Siracusa MC, Saenz SA, Noti M, Monticelli LA, Sonnenberg GF, et al. TSLP elicits IL-33-independent innate lymphoid cell responses to promote skin inflammation. Sci Transl Med. 2013 Jan 30. 5 (170):170ra16. [Medline].
Kim BS, Wang K, Siracusa MC, Saenz SA, Brestoff JR, Monticelli LA, et al. Basophils promote innate lymphoid cell responses in inflamed skin. J Immunol. 2014 Oct 1. 193 (7):3717-25. [Medline].
Roediger B, Kyle R, Yip KH, Sumaria N, Guy TV, Kim BS, et al. Cutaneous immunosurveillance and regulation of inflammation by group 2 innate lymphoid cells. Nat Immunol. 2013 Jun. 14 (6):564-73. [Medline].
Imai Y, Yasuda K, Sakaguchi Y, Haneda T, Mizutani H, Yoshimoto T, et al. Skin-specific expression of IL-33 activates group 2 innate lymphoid cells and elicits atopic dermatitis-like inflammation in mice. Proc Natl Acad Sci U S A. 2013 Aug 20. 110 (34):13921-6. [Medline].
Salimi M, Barlow JL, Saunders SP, Xue L, Gutowska-Owsiak D, Wang X, et al. A role for IL-25 and IL-33-driven type-2 innate lymphoid cells in atopic dermatitis. J Exp Med. 2013 Dec 16. 210 (13):2939-50. [Medline].
Kim BS. Innate lymphoid cells in the skin. J Invest Dermatol. 2015 Mar. 135 (3):673-8. [Medline].
Cevikbas F, Wang X, Akiyama T, Kempkes C, Savinko T, Antal A, et al. A sensory neuron-expressed IL-31 receptor mediates T helper cell-dependent itch: Involvement of TRPV1 and TRPA1. J Allergy Clin Immunol. 2014 Feb. 133 (2):448-60. [Medline].
Oetjen LK, Mack MR, Feng J, et al. Sensory Neurons Co-opt Classical Immune Signaling Pathways to Mediate Chronic Itch. Cell. 2017 Sep 21. 171 (1):217-228.e13. [Medline].
Osawa R, Akiyama M, Shimizu H. Filaggrin gene defects and the risk of developing allergic disorders. Allergol Int. 2011 Mar. 60(1):1-9. [Medline].
Smith FJ, Irvine AD, Terron-Kwiatkowski A, et al. Loss-of-function mutations in the gene encoding filaggrin cause ichthyosis vulgaris. Nat Genet. 2006 Mar. 38(3):337-42. [Medline].
Palmer CN, Irvine AD, Terron-Kwiatkowski A, et al. Common loss-of-function variants of the epidermal barrier protein filaggrin are a major predisposing factor for atopic dermatitis. Nat Genet. 2006 Apr. 38(4):441-6. [Medline].
Hvid M, Vestergaard C, Kemp K, Christensen GB, Deleuran B, Deleuran M. IL-25 in atopic dermatitis: a possible link between inflammation and skin barrier dysfunction?. J Invest Dermatol. 2011 Jan. 131 (1):150-7. [Medline].
Savinko T, Matikainen S, Saarialho-Kere U, Lehto M, Wang G, Lehtimäki S, et al. IL-33 and ST2 in atopic dermatitis: expression profiles and modulation by triggering factors. J Invest Dermatol. 2012 May. 132 (5):1392-400. [Medline].
Soumelis V, Reche PA, Kanzler H, Yuan W, Edward G, Homey B, et al. Human epithelial cells trigger dendritic cell mediated allergic inflammation by producing TSLP. Nat Immunol. 2002 Jul. 3 (7):673-80. [Medline].
Brandt EB, Sivaprasad U. Th2 Cytokines and Atopic Dermatitis. J Clin Cell Immunol. 2011 Aug 10. 2(3):[Medline]. [Full Text].
Margolis DJ, Kim B, Apter AJ, Gupta J, Hoffstad O, Papadopoulos M, et al. Thymic stromal lymphopoietin variation, filaggrin loss of function, and the persistence of atopic dermatitis. JAMA Dermatol. 2014 Mar. 150 (3):254-9. [Medline].
Kubo A, Nagao K, Amagai M. Epidermal barrier dysfunction and cutaneous sensitization in atopic diseases. J Clin Invest. 2012 Feb 1. 122(2):440-7. [Medline]. [Full Text].
Sun LD, Xiao FL, Li Y, et al. Genome-wide association study identifies two new susceptibility loci for atopic dermatitis in the Chinese Han population. Nat Genet. 2011 Jun 12. 43(7):690-4. [Medline].
Paternoster L, Standl M, Chen CM, et al. Meta-analysis of genome-wide association studies identifies three new risk loci for atopic dermatitis. Nat Genet. 2011 Dec 25. 44(2):187-92. [Medline]. [Full Text].
Williams H, Flohr C. How epidemiology has challenged 3 prevailing concepts about atopic dermatitis. J Allergy Clin Immunol. 2006 Jul. 118(1):209-13. [Medline].
Zutavern A, Hirsch T, Leupold W, Weiland S, Keil U, von Mutius E. Atopic dermatitis, extrinsic atopic dermatitis and the hygiene hypothesis: results from a cross-sectional study. Clin Exp Allergy. 2005 Oct. 35(10):1301-8. [Medline].
Weston S, Halbert A, Richmond P, Prescott SL. Effects of probiotics on atopic dermatitis: a randomised controlled trial. Arch Dis Child. 2005 Sep. 90(9):892-7. [Medline].
Lee CH, Chuang HY, Hong CH, et al. Lifetime exposure to cigarette smoking and the development of adult-onset atopic dermatitis. Br J Dermatol. 2011 Mar. 164(3):483-9. [Medline]. [Full Text].
Horii KA, Simon SD, Liu DY, Sharma V. Atopic dermatitis in children in the United States, 1997-2004: visit trends, patient and provider characteristics, and prescribing patterns. Pediatrics. 2007 Sep. 120(3):e527-34. [Medline].
Williams HC, Pembroke AC, Forsdyke H, Boodoo G, Hay RJ, Burney PG. London-born black Caribbean children are at increased risk of atopic dermatitis. J Am Acad Dermatol. 1995 Feb. 32(2 Pt 1):212-7. [Medline].
Leung DY, Bieber T. Atopic dermatitis. Lancet. 2003 Jan 11. 361(9352):151-60. [Medline].
Fox S. Atopic Dermatitis Symptoms in Children Are Persistent. Medscape Medical News. Available at https://www.medscape.com/viewarticle/823090. Accessed: April 15, 2014.
Margolis JS, Abuabara K, Bilker W, Hoffstad O, Margolis DJ. Persistence of Mild to Moderate Atopic Dermatitis. JAMA Dermatol. 2014 Apr 2. [Medline].
Silverberg JI. Persistence of Childhood Eczema Into Adulthood. JAMA Dermatol. 2014 Apr 2. [Medline].
Armstrong AW, Kim RH, Idriss NZ, Larsen LN, Lio PA. Online video improves clinical outcomes in adults with atopic dermatitis: a randomized controlled trial. J Am Acad Dermatol. 2011 Mar. 64(3):502-7. [Medline].
Garmhausen D, Hagemann T, Bieber T, Dimitriou I, Fimmers R, Diepgen T, et al. Characterization of different courses of atopic dermatitis in adolescent and adult patients. Allergy. 2013 Apr. 68(4):498-506. [Medline].
Hanifin JM, Rajka G. Diagnostic features of atopic dermatitis. Acta Derm Venereol (Stockh). 1980. 92 (suppl):44-7.
Chopra R, Vakharia PP, Sacotte R, Patel N, Immaneni S, White T, et al. Severity strata for Eczema Area and Severity Index (EASI), modified EASI, Scoring Atopic Dermatitis (SCORAD), objective SCORAD, Atopic Dermatitis Severity Index and body surface area in adolescents and adults with atopic dermatitis. Br J Dermatol. 2017 Nov. 177 (5):1316-1321. [Medline].
Schram ME, Spuls PI, Leeflang MM, Lindeboom R, Bos JD, Schmitt J. EASI, (objective) SCORAD and POEM for atopic eczema: responsiveness and minimal clinically important difference. Allergy. 2012 Jan. 67 (1):99-106. [Medline].
Silverberg JI, Gelfand JM, Margolis DJ, Fonacier L, Boguniewicz M, Schwartz LB, et al. Severity strata for POEM, PO-SCORAD, and DLQI in US adults with atopic dermatitis. Ann Allergy Asthma Immunol. 2018 Oct. 121 (4):464-468.e3. [Medline].
Schmitt J, Chen CM, Apfelbacher C, et al. Infant eczema, infant sleeping problems, and mental health at 10 years of age: the prospective birth cohort study LISAplus. Allergy. 2011 Mar. 66(3):404-11. [Medline].
Nikkels AF, Piérard GE. Occult varicella. Pediatr Infect Dis J. 2009 Dec. 28(12):1073-5. [Medline].
Haeck IM, Rouwen TJ, Timmer-de Mik L, et al. Topical corticosteroids in atopic dermatitis and the risk of glaucoma and cataracts. J Am Acad Dermatol. 2011 Feb. 64(2):275-81. [Medline].
Heil PM, Maurer D, Klein B, Hultsch T, Stingl G. Omalizumab therapy in atopic dermatitis: depletion of IgE does not improve the clinical course - a randomized, placebo-controlled and double blind pilot study. J Dtsch Dermatol Ges. 2010 Dec. 8(12):990-8. [Medline].
Beck LA, Thaçi D, Hamilton JD, Graham NM, Bieber T, Rocklin R, et al. Dupilumab treatment in adults with moderate-to-severe atopic dermatitis. N Engl J Med. 2014 Jul 10. 371 (2):130-9. [Medline].
Thaçi D, Simpson EL, Beck LA, Bieber T, Blauvelt A, Papp K, et al. Efficacy and safety of dupilumab in adults with moderate-to-severe atopic dermatitis inadequately controlled by topical treatments: a randomised, placebo-controlled, dose-ranging phase 2b trial. Lancet. 2016 Jan 2. 387 (10013):40-52. [Medline].
Simpson EL, Bieber T, Guttman-Yassky E, Beck LA, Blauvelt A, Cork MJ, et al. Two Phase 3 Trials of Dupilumab versus Placebo in Atopic Dermatitis. N Engl J Med. 2016 Dec 15. 375 (24):2335-2348. [Medline].
Simpson EL, et al. Dupilumab efficacy and safety in adolescents with moderate-to-severe atopic dermatitis: Results from a multicenter, randomized, placebo-controlled, double-blind, parallel-group, Phase 3 study (abstract #4640). Presented at the 27th European Academy of Dermatology and Venereology (EADV) Congress. September 15, 2018. Paris, France. [Full Text].
Paller AS, Siegfried E, Gooderham M, Beck LA, Boguniewica M, Sher L, et al. Dupilumab significantly improves atopic dermatitis in children aged 6 to 12 years: Results from phase 3 trial (LIBERTY AD PEDS) (abstract 215). Presented at Revolutionizing Atopic Dermatitis 2020 virtual meeting. April 5, 2020. [Full Text].
AnaptysBio. AnaptysBio Reports Positive Topline Proof-of-Concept Data from Phase 2a Clinical Trial of ANB020 in Atopic Dermatitis. Available at https://ir.anaptysbio.com/phoenix.zhtml?c=254208&p=irol-newsArticle&ID=2305583. October 10, 2017; Accessed: November 13, 2017.
Schwartz DM, Bonelli M, Gadina M, O'Shea JJ. Type I/II cytokines, JAKs, and new strategies for treating autoimmune diseases. Nat Rev Rheumatol. 2016 Jan. 12 (1):25-36. [Medline].
AbbVie. AbbVie's Upadacitinib (ABT-494) Meets Primary Endpoint in Phase 2b Study in Atopic Dermatitis. Available at https://news.abbvie.com/news/abbvies-upadacitinib-abt-494-meets-primary-endpoint-in-phase-2b-study-in-atopic-dermatitis.htm. September 7, 2017; Accessed: November 13, 2017.
Eli Lilly and Company. Baricitinib Meets Primary Endpoint in Phase 2 Study of Patients with Moderate-to-Severe Atopic Dermatitis. Available at https://investor.lilly.com/releasedetail.cfm?ReleaseID=1040434. September 14, 2017; Accessed: November 13, 2017.
Bissonnette R, Papp KA, Poulin Y, Gooderham M, Raman M, Mallbris L, et al. Topical tofacitinib for atopic dermatitis: a phase IIa randomized trial. Br J Dermatol. 2016 Nov. 175 (5):902-911. [Medline].
Paller AS, Tom WL, Lebwohl MG, Blumenthal RL, Boguniewicz M, Call RS, et al. Efficacy and safety of crisaborole ointment, a novel, nonsteroidal phosphodiesterase 4 (PDE4) inhibitor for the topical treatment of atopic dermatitis (AD) in children and adults. J Am Acad Dermatol. 2016 Sep. 75 (3):494-503.e4. [Medline]. [Full Text].
Eucrisa (crisaborole) [package insert]. Collegeville, Pa: Anacor Pharmaceuticals, Inc. March 2020. Available at [Full Text].
Michail S. The role of Probiotics in allergic diseases. Allergy Asthma Clin Immunol. 2009 Oct 22. 5(1):5. [Medline]. [Full Text].
Hand L. Probiotics may protect infants from allergy, but not asthma. Medscape Medical News. August 19, 2013. [Full Text].
Elazab N, Mendy A, Gasana J, Vieira ER, Quizon A, Forno E. Probiotic Administration in Early Life, Atopy, and Asthma: A Meta-analysis of Clinical Trials. Pediatrics. 2013 Aug 19. [Medline].
Johnson K. Probiotics in Pregnancy, Lactation Reduce Dermatitis. Medscape Medical News. Nov 25 2014. [Full Text].
[Guideline] Fiocchi A, Pawankar R, Cuello-Garcia C, et al. World Allergy Organization-McMaster University Guidelines for Allergic Disease Prevention (GLAD-P): Probiotics. World Allergy Organ J. 2015. 8 (1):4. [Medline].
Douglas D. Methotrexate assay helpful in some children with skin disease. Medscape Medical News. January 7, 2014. [Full Text].
Rahman SI, Siegfried E, Flanagan KH, Armbrecht ES. The methotrexate polyglutamate assay supports the efficacy of methotrexate for severe inflammatory skin disease in children. J Am Acad Dermatol. 2013 Dec 8. [Medline].
Shi VY, Foolad N, Ornelas JN, Hassoun L, Monico G, Takeda N, et al. Comparing the Effect of Bleach and Water Baths on Skin Barrier Function in Atopic Dermatitis: A Split-Body Randomized Controlled Trial. Br J Dermatol. 2016 Feb 15. [Medline].
[Guideline] American Academy of Dermatology. Atopic dermatitis clinical guideline. Available at https://www.aad.org/practicecenter/quality/clinical-guidelines/atopic-dermatitis. 2014; Accessed: November 9, 2018.
[Guideline] Berth-Jones J, Exton LS, Ladoyanni E, Mohd Mustapa MF, Tebbs VM, Yesudian PD, et al. British Association of Dermatologists guidelines for the safe and effective prescribing of oral ciclosporin in dermatology 2018. Br J Dermatol. 2019 Jun. 180 (6):1312-1338. [Medline]. [Full Text].

Media Gallery

Atopic dermatitis. Typical atopic dermatitis on the face of an infant.
Atopic dermatitis. Flexural involvement in childhood atopic dermatitis.
Atopic dermatitis. Dirty neck sign in chronic atopic dermatitis.
Atopic dermatitis. Irritation around mouth of an infant with atopic dermatitis.

of 4

Author

Brian S Kim, MD, MTR, FAAD Associate Professor of Medicine (Dermatology), Anesthesiology, and Pathology and Immunology, Co-Director, Center for the Study of Itch, Department of Medicine, Division of Dermatology, Washington University in St Louis School of Medicine

Brian S Kim, MD, MTR, FAAD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Society for Investigative Dermatology

Disclosure: Received research grant from: Doris Duke Charitable Foundation, Celgene Corporation, LEO Pharma, and the National Institute of Arthritis Musculoskeletal and Skin Diseases (NIAMS) of the National Institutes of Health [NIH (K08AR065577 and R01AR070116)]<br/>Consultant for AbbVie, Inc, Menlo Therapeutics, Pfizer, Inc, Regeneron, Sanofi Genzyme; Advisory Board member for Boehringer Ingelheim, Cara Therapeutics, Kiniksa Pharmaceuticals, Menlo Therapeutics, Trevi Therapeutics; Founder of Nuogen Pharma, Inc.

Specialty Editor Board

Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

Van Perry, MD Assistant Professor, Department of Medicine, Division of Dermatology, University of Texas School of Medicine at San Antonio

Van Perry, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD.

Acknowledgements

Peter Fritsch, MD Chair, Department of Dermatology and Venereology, University of Innsbruck, Austria

Peter Fritsch, MD is a member of the following medical societies: American Dermatological Association, International Society of Pediatric Dermatology, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Bernice R Krafchik, MBChB, FRCPC Professor Emeritus, Department of Pediatrics, Section of Dermatology, University of Toronto

Bernice R Krafchik, MBChB, FRCPC is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, Canadian Medical Association, College of Physicians and Surgeons of Ontario, Royal College of Physicians and Surgeons of Canada, and Society for Pediatric Dermatology

Disclosure: Nothing to disclose.

Which medications in the drug class Antibiotics are used in the treatment of Atopic Dermatitis?

Antibiotics

Cephalexin (Keflex)

Penicillin VK (Beepen-VK, Betapen-VK, Veetids)

Clindamycin (Cleocin)

Mupirocin (Bactroban, Bactroban Nasal, Centany)

Trimethoprim/sulfamethoxazole (Bactrim, Bactrim DS, Cotrim)

Related Questions:

References

Tables

Contributor Information and Disclosures