Can I take Zpak (azithromycin) for dermatitis flare-ups?

Azithromycin (Zpak) Is Not Recommended for Dermatitis Flare-ups

Systemic antibiotics like azithromycin (Zpak) should not be used for dermatitis flare-ups unless there is clear clinical evidence of bacterial infection. 1

Why Antibiotics Are Not Appropriate for Routine Dermatitis Treatment

• Systemic antibiotics are only recommended for atopic dermatitis when there is clinical evidence of bacterial infection, not for routine management of flare-ups 1
• While Staphylococcus aureus colonizes the skin of over 90% of adult atopic dermatitis patients, most do not show increased morbidity from this colonization alone 1
• The use of systemic antibiotics in non-infected dermatitis is not recommended according to guidelines 1

When Antibiotics May Be Considered

Antibiotics may be appropriate only in specific circumstances:

• When there are clear signs of secondary bacterial infection such as:

  • Purulent exudate and pustules (rather than just inflammation) 1
  • Crusting that appears infected rather than just part of the dermatitis 1
  • Failure to respond to standard dermatitis treatments 1

• Clinical signs that help distinguish infection from inflammation include:

  • Presence of purulent drainage
  • Yellow crusting
  • Pustules on arms, legs, and trunk (not just typical dermatitis areas) 1

Risks of Inappropriate Antibiotic Use

Using azithromycin for dermatitis without infection carries several risks:

• Development of bacterial resistance, which can reduce effectiveness of future treatments 1
• Potential adverse effects of azithromycin including:
  • Cardiovascular: palpitations, chest pain, arrhythmias, QT prolongation, torsade de pointes 1
  • Gastrointestinal: dyspepsia, diarrhea, nausea, vomiting, abdominal pain 1
  • Skin reactions: pruritus, erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis 1
  • Allergic reactions: rash, photosensitivity, angioedema 1

Recommended Treatments for Dermatitis Flare-ups

Instead of antibiotics, the following treatments are recommended for dermatitis flare-ups:

First-line treatments:

• Topical corticosteroids appropriate to the severity of the flare-up 1
• Moisturizers (preferably with urea 5-10%) applied at least twice daily 1
• Avoidance of skin irritants and excessive washing with hot water 1

For moderate-to-severe flares:

• Topical corticosteroids of appropriate potency 1
• Systemic corticosteroids may be considered for short-term use in severe cases 1
• Phototherapy for recalcitrant cases 1

When Antibiotics Are Appropriate

If there is clear evidence of secondary bacterial infection in dermatitis:

• Obtain bacterial culture and sensitivity testing before starting antibiotics 1
• Choose an antibiotic based on sensitivity results, with flucloxacillin typically being first-line for Staphylococcus aureus 1
• For penicillin allergy, erythromycin may be used 1
• Treat for at least 14 days based on sensitivities 1

Common Pitfalls to Avoid

• Mistaking normal dermatitis inflammation for infection 1
• Using antibiotics "just in case" without clear evidence of infection 1
• Continuing antibiotics long-term, which can lead to resistance 1
• Not addressing the underlying dermatitis with appropriate anti-inflammatory treatments 1
• Failing to recognize viral infections like eczema herpeticum, which requires antiviral therapy, not antibiotics 1

Conclusion for Clinical Practice

When faced with a dermatitis flare-up, focus on optimizing anti-inflammatory treatments and skin barrier repair rather than reaching for antibiotics. Only use systemic antibiotics like azithromycin when there are clear signs of secondary bacterial infection, not as a routine treatment for dermatitis flares.