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Dermatitis - contact - Management
How should I manage secondary infection?
- Suspect secondary infection if clinical signs of infection are present, for example rapid worsening of dermatitis with marked erythema, discharge, or increased pain. The person will often feel unwell or feverish:
- The typical appearance of impetigo (crusted lesions that may be yellow) may be difficult to distinguish from dermatitis.
- It is common practice to have a low threshold of diagnosing infection when dermatitis is severe or unexpectedly deteriorates.
- For visibly infected dermatitis, swab the skin and start oral antibiotics:
- Flucloxacillin or clarithromycin (if the person is allergic to penicillin) is recommended first-line.
- If visible infection fails to respond to a first-line antibiotic, microbiological investigations to ascertain sensitivities may be useful.
Basis for recommendation
- The recommendation to use oral flucloxacillin or clarithromycin is in line with the national guidance on the management of impetigo [HPA and Association of Medical Microbiologists, 2008].
- CKS found no randomized controlled trial evidence to support the use of antibiotics when there is no visible sign of infection.
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