mupirocin and Impetigo

Impetigo, a highly contagious bacterial skin infection commonly occurring in young children, but adults may also be affected. The superficial skin infection is mainly caused by Staphylococcus aureus (S. aureus) and less frequently by Streptococcus pyogenes (S. pyogenes). Antimicrobial resistance has become a worldwide concern and needs to be addressed when selecting treatment for impetigo patients. An evidence-based impetigo treatment algorithm was developed to address the treatment of impetigo for pediatric and adult populations.. An international panel of pediatric dermatologists, dermatologists, pediatricians, and pediatric infectious disease specialists employed a modified Delphi technique to develop the impetigo treatment algorithm. Treatment recommendations were evidence-based, taking into account antimicrobial stewardship and the increasing resistance to oral and topical antibiotics.. The algorithm includes education and prevention of impetigo, diagnosis and classification, treatment measures, and follow-up and distinguishes between localized and widespread or epidemic outbreaks of impetigo. The panel adopted the definition of localized impetigo of fewer than ten lesions and smaller than 36 cm2 area affected in patients of two months and up with no compromised immune status. Resistance to oral and topical antibiotics prescribed for the treatment of impetigo such as mupirocin, retapamulin, fusidic acid, have been widely reported.. When prescribing antibiotics, it is essential to know the local trends in antibiotic resistance. Ozenoxacin cream 1% is highly effective against S. pyogenes and S. aureus, including methycyllin-susceptible and resistant strains (MRSA), and may be a suitable option for localized impetigo.J Drugs Dermatol. 2021;20(2):134-142. doi:10.36849/JDD.5475 \ \ THIS ARTICLE HAD BEEN MADE AVAILABLE FREE OF CHARGE. PLEASE SCROLL DOWN TO ACCESS THE FULL TEXT OF THIS ARTICLE WITHOUT LOGGING IN. NO PURCHASE NECESSARY. PLEASE CONTACT THE PUBLISHER WITH ANY QUESTIONS.

Topics: Aminopyridines; Anti-Bacterial Agents; Antimicrobial Stewardship; Bridged Bicyclo Compounds, Heterocyclic; Critical Pathways; Delphi Technique; Diterpenes; Drug Resistance, Bacterial; Evidence-Based Medicine; Fusidic Acid; Humans; Impetigo; Microbial Sensitivity Tests; Mupirocin; Practice Guidelines as Topic; Quinolones; Skin Cream; Staphylococcus aureus; Streptococcus pyogenes; Systematic Reviews as Topic

Topics: Administration, Topical; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Anti-Infective Agents, Local; Bacitracin; Bridged Bicyclo Compounds, Heterocyclic; Cephalexin; Clindamycin; Cloxacillin; Dicloxacillin; Diterpenes; Erythromycin; Fusidic Acid; Gentamicins; Humans; Impetigo; Meta-Analysis as Topic; Mupirocin; Randomized Controlled Trials as Topic

Impetigo is a common, superficial bacterial skin infection, which is most frequently encountered in children. There is no generally agreed standard therapy, and guidelines for treatment differ widely. Treatment options include many different oral and topical antibiotics as well as disinfectants. This is an updated version of the original review published in 2003.. To assess the effects of treatments for impetigo, including non-pharmacological interventions and 'waiting for natural resolution'.. We updated our searches of the following databases to July 2010: the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (from 2005), EMBASE (from 2007), and LILACS (from 1982). We also searched online trials registries for ongoing trials, and we handsearched the reference lists of new studies found in the updated search.. Randomised controlled trials of treatments for non-bullous, bullous, primary, and secondary impetigo.. Two independent authors undertook all steps in data collection. We performed quality assessments and data collection in two separate stages.. We included 57 trials in the first version of this review. For this update 1 of those trials was excluded and 12 new trials were added. The total number of included trials was, thus, 68, with 5578 participants, reporting on 50 different treatments, including placebo. Most trials were in primary impetigo or did not specify this.For many of the items that were assessed for risk of bias, most studies did not provide enough information. Fifteen studies reported blinding of participants and outcome assessors.Topical antibiotic treatment showed better cure rates than placebo (pooled risk ratio (RR) 2. 24, 95% confidence interval (CI) 1.61 to 3.13) in 6 studies with 575 participants. In 4 studies with 440 participants, there was no clear evidence that either of the most commonly studied topical antibiotics (mupirocin and fusidic acid) was more effective than the other (RR 1.03, 95% CI 0.95 to 1.11).In 10 studies with 581 participants, topical mupirocin was shown to be slightly superior to oral erythromycin (pooled RR 1.07, 95% CI 1.01 to 1.13). There were no significant differences in cure rates from treatment with topical versus other oral antibiotics. There were, however, differences in the outcome from treatment with different oral antibiotics: penicillin was inferior to erythromycin, in 2 studies with 79 participants (pooled RR 1.29, 95% CI 1.07 to 1.56), and cloxacillin, in 2 studies with 166 participants (pooled RR 1.59, 95% CI 1.21 to 2.08).There was a lack of evidence for the benefit of using disinfectant solutions. When 2 studies with 292 participants were pooled, topical antibiotics were significantly better than disinfecting treatments (RR 1.15, 95% CI 1.01 to 1.32).The reported number of side-effects was low, and most of these were mild. Side-effects were more common for oral antibiotic treatment compared to topical treatment. Gastrointestinal effects accounted for most of the difference.Worldwide, bacteria causing impetigo show growing resistance rates for commonly used antibiotics. For a newly developed topical treatment, retapamulin, no resistance has yet been reported.. There is good evidence that topical mupirocin and topical fusidic acid are equally, or more, effective than oral treatment. Due to the lack of studies in people with extensive impetigo, it is unclear if oral antibiotics are superior to topical antibiotics in this group. Fusidic acid and mupirocin are of similar efficacy. Penicillin was not as effective as most other antibiotics. There is a lack of evidence to support disinfection measures to manage impetigo.

Topics: Administration, Oral; Administration, Topical; Anti-Bacterial Agents; Erythromycin; Fusidic Acid; Humans; Impetigo; Mupirocin; Penicillins; Randomized Controlled Trials as Topic

Selective immunoglobulin M (IgM) deficiency is a rare disorder defined by a decreased serum level of IgM and normal levels of other immunoglobulin classes. The disease has not been well described and the cause remains unknown. Patients with IgM deficiency may present with a wide spectrum of clinical manifestations, from asymptomatic to life-threatening infections, including recurrent respiratory and gastrointestinal infections, allergy and autoimmunity. Here, we report a 6.5-year-old otherwise healthy boy with selective IgM deficiency who presented with multiple recurrent impetigo. We reviewed the published data regarding selective deficiency of IgM.

Topics: Amoxicillin; Anti-Bacterial Agents; Child; Clavulanic Acid; Dysgammaglobulinemia; Humans; Immunoglobulin M; Impetigo; Lymphocyte Subsets; Male; Mupirocin; Recurrence

Topics: Administration, Oral; Adult; Amoxicillin; Anti-Bacterial Agents; Anti-Infective Agents; Anti-Infective Agents, Local; Azithromycin; Cephalosporins; Child; Clavulanic Acid; Clinical Trials as Topic; Diagnosis, Differential; Drug Therapy, Combination; Female; Fusidic Acid; Humans; Impetigo; Infant; Male; Methicillin; Mupirocin; Ointments; Penicillins; Pregnancy; Pristinamycin; Sulfadiazine; Time Factors

Impetigo contagiosa is a common, superficial, bacterial infection of the skin characterised by an inflamed and infected epidermis caused by Staphylococcus aureus, Streptococcus pyogenes or both. The less common bullous impetigo is characterised by fragile fluid-filled vesicles and flaccid blisters, and is invariably caused by pathogenic strains of S. aureus. In bullous impetigo, exfoliative toxins are produced, although these are restricted to the area of infection and bacteria can be cultured from the blister contents. In the rare variant, staphylococcal scalded skin syndrome, the exfoliative toxins are spread haematogenously from a localised source causing widespread epidermal damage at distant sites.

Topics: Anti-Bacterial Agents; Child; Drug Resistance, Bacterial; Erythromycin; Fusidic Acid; Humans; Impetigo; Infant; Mupirocin; Randomized Controlled Trials as Topic; Staphylococcal Scalded Skin Syndrome; Staphylococcus aureus; Streptococcus pyogenes

Impetigo is a common clinical problem seen in general practice. Uncertainty exists as to the most effective treatment, or indeed if treatment is necessary.. To determine the most effective treatment for impetigo in a systemically well patient.. Systematic review and meta-analysis.. Databases were searched for relevant studies. The Cochrane highly sensitive randomised controlled trial (RCT) search string was employed and combined with the word 'impetigo' as the MeSH term and keyword. The bibliographies of relevant articles were searched for additional references. RCTs that were either double- or observer-blind, and involved systemically well patients of any age in either primary or secondary care settings, were included. Studies that selected patients on the basis of skin swab results were excluded, as were studies that were not in English. Cure or improvement of impetigo reported at seven to 14 days from start of treatment was the primary outcome measure. Meta-analysis was performed on homogeneous studies.. Three hundred and fifty-nine studies were identified, of which 16 met the inclusion criteria. Meta-analysis demonstrated that topical antibiotics are more effective than placebo (odds ratio [OR] = 2.69, 95% confidence interval [CI] = 1.49 to 4.86). There is weak evidence for the superiority of topical antibiotics over some oral antibiotics, such as erythromycin (OR = 0.48, 95% CI = 0.23 to 1.00). There is no significant difference between the effects of mupirocin and fusidic acid (OR = 1.76, 95% CI = 0.77 to 4.03).. This review found limited high-quality evidence to inform the treatment of impetigo. From that which is available, we would recommend the use of a topical antibiotic for a period of seven days in a systemically well patient with limited disease. Further research is needed on the role of flucloxacillin and non-antibiotic treatments for impetigo.

Topics: Administration, Topical; Adolescent; Algorithms; Child; Child, Preschool; Double-Blind Method; Drug Therapy, Combination; Erythromycin; Family Practice; Fusidic Acid; Humans; Impetigo; Infant; Infant, Newborn; Mupirocin; Randomized Controlled Trials as Topic; Treatment Outcome

Topics: Administration, Oral; Administration, Topical; Amoxicillin; Anti-Bacterial Agents; Cephalexin; Child; Child, Preschool; Diagnosis, Differential; Floxacillin; Humans; Impetigo; Infant; Mupirocin; Staphylococcus aureus; Streptococcus pyogenes

The introduction of mupirocin ointment gives the pediatrician a reliable topical alternative to oral antibiotic therapy for group A streptococcal and staphylococcal impetigo. It is as effective as oral antibiotics and is associated with fewer adverse effects. In superficial skin infections that are not widespread, mupirocin ointment offers several advantages. It is highly active against the most frequent skin pathogens, even those resistant to other antibiotics, and the topical route of administration allows delivery of high drug concentrations to the site of infection.

Topics: Administration, Topical; Child; Humans; Impetigo; Mupirocin; Ointments

Topics: Humans; Impetigo; Mupirocin

Topics: Anti-Bacterial Agents; Erythromycin; Humans; Impetigo; Mupirocin; Penicillins; Staphylococcal Infections; Streptococcal Infections; Streptococcus pyogenes

Topics: Administration, Cutaneous; Anti-Bacterial Agents; Fatty Acids; Half-Life; Humans; Impetigo; Mupirocin

Mupirocin is a novel antibiotic totally unrelated in chemical structure and mode of action to any other clinically useful class of antibiotics. It has greatest antibacterial activity against aerobic gram-positive cocci, namely, Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pyogenes, and other beta-hemolytic streptococci. Bactroban ointment is formulated as 2% mupirocin in polyethylene glycol ointment. No systemic absorption of mupirocin or its major metabolite, monic acid, has been detected in short courses of topical administration to healthy volunteers or to patients with epidermolysis bullosa after prolonged courses of therapy with Bactroban ointment. Randomized, multicenter, double-blind, vehicle-controlled clinical trials have shown that mupirocin is safe and effective for the treatment of impetigo.

Topics: Anti-Bacterial Agents; Bacterial Infections; Clinical Trials as Topic; Drug Resistance, Microbial; Fatty Acids; Humans; Impetigo; Mupirocin; Staphylococcal Skin Infections

Terbinafine is an antifungal drug known to have also antibacterial activity against certain Gram-positive and Gram-negative bacteria. It seems that antibacterial and antifungal activity of terbinafine may have an advantage in the treatment of mixed fungal and bacterial superficial skin infections. Nevertheless, clinical relevance of the antibacterial part of its action has not been investigated efficiently. To compare the efficacy and safety of terbinafine with those of mupirocin, which has already proven antibacterial action, in the treatment of impetigo.. Children clinically diagnosed as having impetigo were treated with topical mupirocin or topical terbinafine in a randomized fashion. Patients' lesions were examined clinically on days 0, 4, 7, 10 and bacteriologic cultures were obtained on days 0 and 10.. A total of 62 patients were included in the study. Forty-eight of these patients were eligible for the efficacy and safety analysis. Twenty-five and 23 patients were treated with mupirocin and terbinafine, respectively. The clinical cure rates were 100% for the mupirocin group and 70% for the terbinafine group (p < 0.05). The bacteriological eradication rate for mupirocin-treated children was 100% and that for terbinafine-treated children was 78% (p < 0.05). Presence of bullous lesions appeared to be a factor for poor clinical outcome in the terbinafine group. Mild local adverse effects were noted in a small percentage of patients in each group.. Antibacterial activity of terbinafine is not strong enough to be an alternative in the treatment of impertigo. It is advisable that terbinafine could be used in combination with an antibacterial drug for superficial skin infections caused by both fungi and bacteria.

Topics: Anti-Bacterial Agents; Antifungal Agents; Child; Child, Preschool; Female; Humans; Impetigo; Infant; Male; Mupirocin; Naphthalenes; Terbinafine; Treatment Outcome

Staphylococcus aureus has been consistently isolated from a high proportion of impetiginous lesions, and in several recent studies, it was present in the majority of the cases. Since recently a large proportion of S. aureus strains in our community showed erythromycin resistance, we undertook a prospective double-blind controlled study comparing topical mupirocin with oral erythromycin to determine (i) the prevalence of erythromycin-resistant S. aureus strains in impetigo and (ii) whether an increased rate of failure of erythromycin treatment was associated with such resistance. A total of 102 patients 3 to 185 months old (median = 49 months) were enrolled. Culture was positive for 97 of 102 (95%) patients, and S. aureus was present in 93% of the patients for whom cultures were positive. S. aureus was the single pathogen in 64% of these patients. Erythromycin-resistant S. aureus strains were present in 27 of 91 (28%) patients for whom cultures were positive. In all cases but one, S. aureus was resistant to penicillin, and in all cases it was sensitive to mupirocin. A marked difference was observed in favor of mupirocin in the clinical courses of the disease. However, only patients with erythromycin-resistant S. aureus strains had unfavorable courses compared with those treated with mupirocin (failure rate, 47 versus 2%, respectively). Patients with erythromycin-susceptible S. aureus strains who received erythromycin had a failure rate of 8%. In four patients, S. aureus strains initially susceptible to erythromycin became resistant during treatment. We conclude that erythromycin-resistant S. aureus strains are commonly isolated from impetigo in our region.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Bacteria; Child; Child, Preschool; Double-Blind Method; Drug Resistance, Microbial; Erythromycin; Female; Humans; Impetigo; Infant; Israel; Male; Microbial Sensitivity Tests; Mupirocin; Patient Compliance; Penicillin Resistance; Staphylococcus aureus

A new topical antibiotic, mupirocin, has been found to be as effective as erythromycin for the treatment of impetigo, but concerns about its expense have been raised. This controlled clinical trial sought to compare the cost-effectiveness of erythromycin (E) and mupirocin (M). Ninety-three children, aged 3 months to 16 years, were randomly assigned to receive 10 days of oral erythromycin (n = 46) or topical mupirocin (n = 47). Costs and effects were measured through structured interviews. Cost per case differed significantly by group (E = $56.85; M = $62.30; P less than .05) due chiefly to extra visits and medication changes needed by those treated with mupirocin. Erythromycin and mupirocin were equally effective. The likelihood of side effects (E = 43%, M = 22%) approached significance (P less than .07); those treated with erythromycin were willing to pay more for a different medicine to avoid the side effects experienced (P less than .05). Working parents and school-age children were more likely to alter their daily activities when the patient was taking erythromycin (P less than .04). Compliance and parental satisfaction did not differ by treatment group; however, parents of children treated with erythromycin were more likely to prefer the alternate drug regimen. It is concluded that the type of medication prescribed can be based on parental preference because the increased cost of mupirocin is offset by increased side effects and number of schooldays and workdays lost with erythromycin.

Topics: Baltimore; Child; Cost-Benefit Analysis; Drug Costs; Erythromycin; Female; Humans; Impetigo; Male; Mupirocin; Patient Compliance; Patient Satisfaction

Topics: Administration, Topical; Adolescent; Anti-Bacterial Agents; Child; Child, Preschool; Erythromycin; Fatty Acids; Humans; Impetigo; Infant; Mupirocin

Mupirocin is a novel antibiotic totally unrelated in chemical structure and mode of action to any other clinically useful class of antibiotics. It has greatest antibacterial activity against aerobic gram-positive cocci, namely, Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pyogenes, and other beta-hemolytic streptococci. Bactroban ointment is formulated as 2% mupirocin in polyethylene glycol ointment. No systemic absorption of mupirocin or its major metabolite, monic acid, has been detected in short courses of topical administration to healthy volunteers or to patients with epidermolysis bullosa after prolonged courses of therapy with Bactroban ointment. Randomized, multicenter, double-blind, vehicle-controlled clinical trials have shown that mupirocin is safe and effective for the treatment of impetigo.

Topics: Anti-Bacterial Agents; Bacterial Infections; Clinical Trials as Topic; Drug Resistance, Microbial; Fatty Acids; Humans; Impetigo; Mupirocin; Staphylococcal Skin Infections

Sixty patients participated in a bacteriologically controlled, randomized, parallel group comparison of 2% mupirocin ointment (Bactroban) and oral erythromycin ethylsuccinate for the treatment of impetigo. The trial included clinical and bacteriologic evidence and safety assessments. The Investigator's Global Evaluation, which compared the overall efficacy and safety of the trial drugs, demonstrated a more favorable performance for the mupirocin regimen. This difference was statistically and clinically significant. There were no significant differences between the trial regimens for any of the other efficacy variables examined. The bacteriologic success rate was 100% for both treatment groups. There was a clinically significant difference in adverse experience rates between treatment groups, with four (13%) of the erythromycin-treated patients reporting six adverse experiences versus none of the mupirocin-treated patients. The results of the trial indicate that 2% mupirocin ointment is as safe and effective as oral erythromycin ethylsuccinate in the treatment of patients with impetigo.

Topics: Erythromycin; Fatty Acids; Female; Humans; Impetigo; Male; Mupirocin; Ointments; Randomized Controlled Trials as Topic; Staphylococcal Skin Infections; Staphylococcus aureus; Streptococcal Infections; Streptococcus pyogenes

Topics: Anti-Bacterial Agents; Child; Child, Preschool; Double-Blind Method; Erythromycin; Fatty Acids; Female; Humans; Impetigo; Infant; Male; Mupirocin

Ninety-seven patients with impetigo were prospectively enrolled in a study to determine the comparative efficacy of systemic and topical antibiotic therapy. After obtaining a bacterial culture from a representative lesion, the children were randomized to receive seven days of either oral erythromycin or topical mupirocin administered three times daily. Staphylococcus aureus alone was isolated from 51% and in association with group A beta-hemolytic streptococci (GABS) from 29%; GABS alone was isolated from 4% of patients. Of 48 children who received erythromycin, 43 (90%) were clinically improved or cured, and 11 of 17 were bacteriologically cured. Of 49 children who received mupirocin, 47 (96%) were clinically improved or cured, and 10 of 14 were bacteriologically cured. At three-week follow-up, clinical cure rates and number of secondary household cases of impetigo were equivalent in both treatment groups. Mupirocin appears to be a well-tolerated, albeit expensive, alternative to erythromycin for the treatment of impetigo.

Topics: Administration, Oral; Administration, Topical; Adolescent; Anti-Bacterial Agents; Child; Child, Preschool; Drug Resistance, Microbial; Erythromycin; Fatty Acids; Female; Humans; Impetigo; Infant; Male; Mupirocin; Prospective Studies; Random Allocation; Staphylococcus aureus; Streptococcus

Topical antimicrobial therapy has not been effective in the past against cutaneous bacterial infections. In this study, a new topical antibiotic ointment, mupirocin, was compared with oral erythromycin ethylsuccinate in the treatment of impetigo. Seventy-five patients clinically diagnosed as having impetigo and with positive cultures of Staphylococcus aureus, Streptococcus pyogenes, or both were examined in an investigator-blinded study. Patients used topical mupirocin applied three times daily or the usual oral dose of erythromycin ethylsuccinate (30 to 50 mg/kg per day). Patients' lesions were examined clinically and cultured bacteriologically on days 0, 3, and 8, and 1 week after treatment. Susceptibility testing was performed on pathogens isolated to determine antibiotic resistance. Mupirocin treatment produced similar clinical results to oral erythromycin and was superior in the eradication of S aureus, including antibiotic-resistant S aureus. These results show topical mupirocin to be a safe and effective alternative to oral antibiotic therapy in the treatment of impetigo.

Topics: Administration, Oral; Administration, Topical; Anti-Bacterial Agents; Child, Preschool; Erythromycin; Fatty Acids; Female; Humans; Impetigo; Male; Mupirocin; Penicillin Resistance; Random Allocation; Staphylococcus aureus; Streptococcus pyogenes

Topics: Administration, Cutaneous; Anti-Bacterial Agents; Child; Clinical Trials as Topic; Fatty Acids; Humans; Impetigo; Mupirocin; Ointments

Sodium fusidate ointment and mupirocin ointment were compared in 354 patients with superficial skin sepsis. The ointments were applied 3-times daily, or once daily when covered by a dressing, and the response assessed after 6 to 8 days. Both preparations proved effective clinically with 86% of patients responding. There was no difference between the two preparations in cases of primary infection (85% to both ointments), including a sub-group with impetigo (sodium fusidate 88% and mupirocin 84%), or secondary infection (sodium fusidate 81% and mupirocin 89%). Sodium fusidate ointment (98%) was significantly better (p less than 0.05) than mupirocin (82%) in patients with other superficial infections. Both ointments were equally effective in cases where Gram-positive, Gram-negative or mixed Gram-positive/Gram-negative bacteria were isolated. Adverse effects were reported in 1.0% of patients using sodium fusidate ointment and in 7.4% of patients using mupirocin ointment. The majority of complaints concerned the greasiness of mupirocin ointment.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Child; Child, Preschool; Fatty Acids; Female; Fusidic Acid; Humans; Impetigo; Infant; Male; Middle Aged; Mupirocin; Ointments; Skin Diseases, Infectious

The safety and efficacy of a new topical antiinfective agent, mupirocin, was compared with that of oral erythromycin ethylsuccinate in the treatment of impetigo in children. Sixty-two children aged 5 months to 13 years with impetigo were assigned to be treated with either mupirocin in three daily applications or erythromycin ethylsuccinate (40 mg/kg of body weight per day divided into four doses) according to a randomized treatment schedule. On the initial visit, exudate or cleansed infected sites or both were cultured and therapy was begun. All patients were treated for 8 days. Patients were seen again on days 4 to 5 of therapy, at the end of therapy, and 7 days after the end of therapy. Sites of infection were comparable between the groups, as were bacteriologic responses. At the first visit, 24 of 30 children in the mupirocin group and 14 of 32 children in the erythromycin group were cured or had at least a 75% reduction in size of the lesions. At the end of the study, all 29 of the children in the mupirocin group who came to follow-up, compared with 27 of 29 in the erythromycin group, were cured. Side effects were few. Five children in the erythromycin group developed mild diarrhea. Thus, mupirocin appears to be safe and effective in treating impetigo in children. Our data show a trend toward more rapid clinical response with mupirocin than with erythromycin.

Topics: Administration, Oral; Administration, Topical; Adolescent; Anti-Bacterial Agents; Child; Child, Preschool; Clinical Trials as Topic; Erythromycin; Fatty Acids; Female; Humans; Impetigo; Infant; Male; Mupirocin; Random Allocation

Because the effectiveness of topical antimicrobials in the treatment of ecthyma, impetigo, and pyoderma is not well established, the US Food and Drug Administration has recently proposed guidelines for tests of topical antimicrobial efficacy in primary skin infections. The guidelines require both comparison with the agent's base and microbiologic documentation of efficacy. These guidelines were followed in this double-blind, eight-day evaluation of impetigo/ecthyma treated with mupirocin, a new agent that is only active topically. All cultures, before and after therapy, were taken using swabs dipped in neutralizing broth plus 10% fetal bovine serum to minimize antimicrobial "carry over" to the culture plate. Staphylococcus aureus, which was isolated from 94% of the patients before therapy, was eliminated in 88% of the mupirocin-treated patients and 47% of the vehicle-treated patients. Group A beta-hemolytic streptococci were eliminated in 100% of the mupirocin-treated and 0% of the vehicle-treated patients. To our knowledge, this is the first topical antibacterial treatment for primary skin infections proved superior to its vehicle using the proposed US Food and Drug Administration guidelines.

Topics: Administration, Topical; Anti-Bacterial Agents; Child; Child, Preschool; Clinical Trials as Topic; Double-Blind Method; Fatty Acids; Female; Humans; Impetigo; Male; Mupirocin; Pharmaceutical Vehicles; Pyoderma; Random Allocation

Topics: Anti-Bacterial Agents; Child; Child, Preschool; Clinical Trials as Topic; Eczema; Fatty Acids; Female; Humans; Impetigo; Infant; Male; Mupirocin; Pyoderma; Skin Ulcer

Topics: Anti-Bacterial Agents; Cefadroxil; Child; Humans; Impetigo; Male; Mupirocin; Skin Diseases, Vesiculobullous

To assess different concentrations and formulations of topical ozenoxacin using a mouse model of Staphylococcus aureus dermal infection for identification of the best formulation for treating patients with impetigo.. The efficacy of ozenoxacin formulations was compared with vehicle control, mupirocin and retapamulin ointments in a mouse model.. The most effective concentrations of ozenoxacin for reducing S. aureus counts after dermal application were 1 and 2%. Direct comparison of two batches of 1% ozenoxacin ointment and cream with 1% retapamulin and 2% mupirocin ointments in the mouse model showed superior efficacy of ozenoxacin.. 1% ozenoxacin ointment and cream were the most effective formulations in significantly reducing bacterial load in S. aureus dermally infected mice.

Topics: Administration, Topical; Aminopyridines; Animals; Animals, Outbred Strains; Anti-Bacterial Agents; Bridged Bicyclo Compounds, Heterocyclic; Disease Models, Animal; Diterpenes; Dose-Response Relationship, Drug; Humans; Impetigo; Mice; Mupirocin; Ointments; Quinolones; Skin Cream; Staphylococcus aureus; Treatment Outcome; Wound Infection

Topics: Administration, Topical; Anti-Bacterial Agents; Disk Diffusion Antimicrobial Tests; Drug Resistance, Bacterial; Folliculitis; Humans; Impetigo; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Staphylococcal Infections; Staphylococcus aureus

Impetigo, a bacterial skin infection that involves the superficial layers of the skin, is one of the most common skin infections in children ages 2 to 5 but can occur in individuals across the lifespan. This article discusses the diagnosis and management of impetigo in primary care.

Topics: Administration, Oral; Anti-Bacterial Agents; Bridged Bicyclo Compounds, Heterocyclic; Diterpenes; Erythromycin; Humans; Impetigo; Mupirocin; Nurse Practitioners; Ointments; Staphylococcus aureus

Bullous impetigo (BI) is a common dermatologic condition, particularly in children, yet confusion regarding its diagnosis and treatment persists. This study measured pediatricians' ability to diagnose and appropriately treat BI and explored factors that might influence pediatricians' accuracy in managing BI.. We administered an expert-validated survey to 64 pediatrics house staff and faculty at three Johns Hopkins Medicine facilities. The survey requested demographic information, diagnoses for five "unknown" cases, and preferred treatments for localized and widespread BI.. Overall, BI was diagnosed correctly 31.9% of the time. There was little difference between house staff and faculty performance, although faculty 50 years of age and older demonstrated better diagnostic acumen. Regarding treatment of localized BI, 92% of faculty members and 84.6% of house staff listed mupirocin as first- or second-line treatment. The second most common medication listed for localized BI was bacitracin. Regarding treatment of widespread BI, faculty listed cephalexin or clindamycin as first- or second-line treatment 56.0% of the time and house staff listed one of these two medications 51.3% of the time. Results for faculty 50 years of age and older were comparable.. Improved pediatrician proficiency in the diagnosis and treatment of BI is needed for safe, cost-effective management. Physician age and experience appear to have a limited effect on the accuracy of BI diagnosis and management. Future educational efforts must be directed at trainees and their instructors.

Topics: Child; Clinical Competence; Dermatology; Humans; Impetigo; Mupirocin; Primary Health Care; Skin Diseases

The number of patients with impetigo caused by community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has been increasing.. To investigate the antimicrobial susceptibility of S. aureus causing impetigo in children in China from 2003 to 2007 and further characterize isolates of CA-MRSA.. We examined 984 S. aureus isolates for antimicrobial susceptibility to 11 antimicrobials using the agar dilution method. CA-MRSA isolates were analysed for Panton-Valentine leucocidin (PVL) genes, and staphylococcal cassette chromosome mec (SCCmec) typing was performed.. The largest proportion (94.5%) of strains were resistant to penicillin, followed by erythromycin (86.2%) and clindamycin (69.6%). In total 772 of 984 (78.5%) S. aureus strains were multiresistant. The incidence of CA-MRSA was 1.1%, with a high rate of resistance to clindamycin (90.9%) and tetracycline (72.7%), but all were susceptible to ciprofloxacin. The susceptibility profiles of MRSA to other antimicrobial agents were similar to those of methicillin-sensitive S. aureus (MSSA). None of the S. aureus strains were resistant to vancomycin and fusidic acid; moreover, only one strain was resistant to mupirocin. Typing of the SCCmec showed that 54.5% were type IV, 18.2% were type V and 9.1% were type VI. All the PVL-positive CA-MRSA carried SCCmec type IV.. CA-MRSA is still relatively uncommon and heterogeneous in children in China. Penicillin and erythromycin are no longer appropriate agents. Effective antibiotic agents for patients with impetigo are mupirocin and fusidic acid.

Topics: Anti-Bacterial Agents; Child; Child, Preschool; China; DNA, Bacterial; Female; Fusidic Acid; Humans; Impetigo; Infant; Male; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Mupirocin; Staphylococcal Skin Infections; Virulence Factors

Mucous membrane plasmacytosis is a rare, often idiopathic, inflammatory disorder that frequently presents as an erythematous, velvety, or lobulated plaque on a mucosal surface. While mucous membrane plasmacytosis often runs a benign course, plaques are known to erode, ulcerate, and bleed. Moreover, according to a recent review of mucous membrane plasmacytosis, treatments of this disorder are inconsistently successful. We report a case of erosive, hemorrhagic mucous-membrane plasmacytosis of the lips treated successfully with cryotherapy. To the best of our knowledge, this case represents the second case of mucous membrane plasmacytosis successfully treated with cryotherapy. The long term response of our patient's condition to cryotherapy with no functional side effects may warrant further study of this technique for severe erosive mucous membrane plasmacytosis.

Topics: AIDS-Related Opportunistic Infections; Anti-Bacterial Agents; Cryotherapy; Drug Resistance; Hemorrhage; Hepatitis C, Chronic; Humans; Hydrocortisone; Impetigo; Lidocaine; Lip Diseases; Male; Middle Aged; Mouth Mucosa; Mupirocin; Plasma Cells

The skin infections are common in pediatrics, ranging from furonculosis or impetigo to the severe forms of necrotizing dermohypodermitis. The general antibiotic treatments are not always indicated but when they are, they must take into account the resistance of two main species of bacteria (Staphylococcus aureus and Streptococcus pyogenes), the pharmacokinetics-pharmacodynamic parameters and the severity and type of infection. Two situations should be treated by topical treatements: limited impetigo and furonculosis. The two topical antibiotics used preferentially are mupirocine and fucidic acid. Soon, a third topical antibiotic, reptamuline will complete these. For uncomplicated superficial skin infections justifying an oral antibiotic, amoxicillin-clavulanate offers the best guarantee of efficiency. Poor pharmacodynamic-pharmacokinetic must lead to not prescribe oral M penicillins. In case of allergy, a first-generation cephalosporin, a macrolide (if the susceptibility of the strain was checked) or pristinamycine (after 6 years of age) are acceptable alternatives. For dermohypodermitis bacterial antibiotic of choice remains amoxicillin-clavulanate through IV route, to be active against S. pyogenes but also S. aureus and anaerobic bacteria. The IV route is maintained until regression general signs and a relay orally by the same drug is then possible. For toxinic syndromes and necrozing fascitis clindamycin should be added to a beta-lactam because of its action on protein synthesis in particular reducing the toxins production.

Topics: Administration, Oral; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Cellulitis; Cephalosporins; Child; Drug Resistance, Bacterial; Fasciitis, Necrotizing; Furunculosis; Fusidic Acid; Humans; Impetigo; Injections, Intravenous; Macrolides; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Penicillins; Pristinamycin; Skin Diseases, Bacterial; Soft Tissue Infections; Staphylococcal Scalded Skin Syndrome; Staphylococcal Skin Infections; Staphylococcus aureus; Stevens-Johnson Syndrome; Streptococcal Infections; Streptococcus pyogenes

Topics: Administration, Cutaneous; Anti-Infective Agents; Child; Dermatitis, Atopic; Dermatologic Surgical Procedures; Diabetic Foot; Drug Resistance, Bacterial; Epidermolysis Bullosa; Humans; Impetigo; Mupirocin; Patient Compliance; Skin; Skin Diseases, Infectious

Topics: Anti-Bacterial Agents; Humans; Impetigo; Methicillin Resistance; Mupirocin; Staphylococcal Infections; Staphylococcus aureus; Sweden

Topics: Administration, Cutaneous; Anti-Bacterial Agents; Drug Resistance, Bacterial; Humans; Impetigo; Meta-Analysis as Topic; Mupirocin

A new cream formulation of mupirocin developed to improve patient compliance was compared with systemic and topical antibiotics commonly used to treat primary and secondary skin infections. A mouse surgical wound model infected with Staphylococcus aureus or Streptococcus pyogenes was used. Topical treatment was applied at 4 and 10 h postinfection or oral treatment at a clinically relevant dose was administered 4, 8, and 12 h postinfection; treatments were continued three times daily for a further 3 days. Mupirocin cream was significantly more effective than (P < 0.01; two of eight studies) or not significantly different from (six of eight studies) mupirocin ointment in reducing bacterial numbers. Mupirocin cream was similar in efficacy to oral flucloxacillin but significantly more effective (P < 0.001) than oral erythromycin. It was also similar in efficacy to cephalexin against S. pyogenes but superior against S. aureus (P < 0.01). Mupirocin cream had a similar efficacy to fusidic acid cream against S. aureus but was significantly superior against S. pyogenes (P < 0.01). A hamster impetigo model infected with S. aureus was also used. Topical or oral treatment was administered at 24 and 30 h postinfection (also 36 h postinfection for oral therapy) and then three times daily for a further 2 days. On day 5, mupirocin cream was significantly more effective than mupirocin ointment in one study (P < 0.01) and of similar efficacy in the other two studies. Mupirocin cream was not significantly different from fusidic acid cream or neomycin-bacitracin cream, but it was significantly superior (P < 0.01) to oral erythromycin and cephalexin. Mupirocin cream was as effective as, or superior to, oral and other topical agents commonly used for skin infections.

Topics: Administration, Oral; Administration, Topical; Animals; Anti-Bacterial Agents; Bacitracin; Cephalexin; Chemistry, Pharmaceutical; Cricetinae; Erythromycin; Female; Floxacillin; Fusidic Acid; Impetigo; Male; Mice; Mupirocin; Neomycin; Penicillins; Skin Diseases, Bacterial; Staphylococcal Infections; Staphylococcus; Streptococcal Infections; Streptococcus; Wound Infection

Topics: Administration, Oral; Administration, Topical; Anti-Bacterial Agents; Benchmarking; Child, Preschool; Emergency Treatment; Evidence-Based Medicine; Female; Humans; Impetigo; Mupirocin; Patient Selection

Topics: Administration, Oral; Administration, Topical; Anti-Bacterial Agents; Bacitracin; Cephalexin; Child, Preschool; Humans; Impetigo; Mupirocin

Topics: Child; Cost of Illness; Erythromycin; Humans; Impetigo; Mupirocin

Topics: Administration, Cutaneous; Anti-Bacterial Agents; Fatty Acids; Fusidic Acid; Humans; Impetigo; Mupirocin; Ointments

Topics: Anti-Bacterial Agents; Cefadroxil; Erythromycin; Fatty Acids; Humans; Impetigo; Mupirocin