1000 healthy kids aged 3 months to 18 yrs with probable community-associated staph aureus skin/soft tissue (SSTI) or invasive infection randomized to daily hygiene vs that with 2x/week bleach baths for 3 months (see DOI: 10.1093/cid/cit764). basically,
–recurrence of SSTI common: about 50%
–bleach bath consisted of adding 5ml of bleach (regular bleach, 6.0% hypochlorite) to every gallon of bath water, and bathing in that for 15 min 2x/week, for 3 months. 12-month followup. dilute bleach solutions known to kill staph.
–colonization cultures were obtained from nares, pharynx, groin. 56% were colonized with s. aureus at minimum of 1 site (most common = groin in 38%, nares 22%, throat 17%). MRSA (methicillin-resistant) more common in groin and throat, MSSA (methicillin-sensitive) in nose. more colonization in younger ages, esp <2yo
–rate of “medically-attended” recurrent infection: 17% with bleach bath and 20.9% with regular hygiene (not significant, but arguably too small a trial: needed around 1000 kids to detect 50% reduction with 90% power). no diff between MRSA and MSSA infections (though most infections were MRSA). higher rates of infection with more colonization sites culture-positive
–not adverse effects found, other than dry skin in a few kids and burning eyes in 1 patient only.
so, obviously a small study at least in terms of outcomes, only with kids, short-term (3 months of baths, with 12 month follow-up) and not powered to get significant results. but, besides that, pretty intriguing… recurrent staph infections really common in kids and adults. seems like a pretty benign therapy (esp given the alternatives of recurrent courses of antibiotics, need for frequent ER visits, etc — ie alternatives not great). and by my quick and dirty (?) measurements in my bathtub, 6″deep water would require 4 ounces of bleach. so, might be reasonable to try in people with documented recurrent infections???? i checked out the Am Acad of Dermatology website for hidradenitis, and they suggested bleach bath as one approach (1/2 cup non-scented bleach to 1/2 full bathtub of water), noting that it works sometimes.
geoff