Moderne topische Glukokortikoide und Antiinfektiva beim superinfizierten atopischen Ekzem: Bilden Prednicarbat und Dodecyldimethylammoniumchlorid eine rationale Kombination?

Abstract

The addition of an anti-infective to a topical glucocorticoid preparation for superinfected atopic eczema is still controversial. To address this question in the context of the topical glucocorticoids of the non-halogenated double-ester type 0.25% prednicarbate cream was compared to the identical preparation incorporating the same amount of the disinfectant didecyldimethylammoniumchloride in patients suffering from atopic eczema carrying Staphylococcus aureus at a density of more than 10(6) colony-forming units per cm2. One of the preparations was used twice daily over 5 days according to a random plan in a blind fashion. Thereafter treatment was based on either prednicarbate cream or the corresponding vehicle according to clinical needs. Clinical and microbiological evaluation were scheduled for days 0, 6 and 34. Various clinical parameters were addressed individually as well as over all improvement using scores. A total of 143 patients was recruited. The patients of both groups improved rapidly with respect to clinical and microbiological findings. Essentially, there was no difference between the groups. Hence, the addition of an anti-infective to a topical prednicarbate preparation is not to be generally recommended.

Effect of Gentian Violet, Corticosteroid and Tar Preparations in <i>Staphylococcus</i>-aureus-Colonized Atopic Eczema

“…This indicates that the reduction of S. aureus is probably a secondary phenomenon, possibly being due to less favorable skin conditions for colonization. It could also explain why in studies, in which potent topical glucocorticosteroids were applied for a period of 7 days or longer, a significant reduction of S. aureus was demonstrated that was not substantially increased by combining the steroid with an antibiotic [19, 20]. However, data about the kinetics of antibacterial and clinical efficacy are lacking in these studies.…”

Interventions to reduce Staphylococcus aureus in the management of atopic eczema: an updated Cochrane review

“…19 Another study of prednicarbate 0AE25% cream plus didecyldimethyl-ammonium chloride 0AE25% vs. prednicarbate 0AE25% cream in adults found no significant difference in global outcome at the end of treatment (RR 0AE64, 95% CI 0AE25-1AE68). 24 Isolation of S. aureus was similar between the two groups at the end of the study.…”

“…Adverse events requiring withdrawal from treatment.Study or SubgroupKorting et al (1994)24 Wachs et al (1976)19 …”

Silver-Coated Textiles Reduce <i>Staphylococcus aureus </i>Colonization in Patients with Atopic Eczema

“…Since the effectiveness of combining topical antibiotic or anti-infective agents with glucocorticosteroids is still controversially discussed [30], textiles with antibacterial qualities may offer the advantage of enhancing the clinical efficacy of glucocorticosteroid or other anti-inflammatory therapy. In addition, an identical clinical efficacy might be achieved by combining textile antistaphylococcal treatment and steroids of less potency and in this way reducing possible side effects of glucocorticosteroids.…”