povidone-iodine and Impetigo

To test the hypothesis that fusidic acid would not increase the treatment effect of disinfecting with povidone-iodine alone in children with impetigo.. Randomised placebo controlled trial.. General practices in Greater Rotterdam.. 184 children aged 0-12 years with impetigo.. Clinical cure and bacterial cure after one week.. After one week of treatment 55% of the patients in the fusidic acid group were clinically cured compared with 13% in the placebo group (odds ratio 12.6, 95% confidence interval 5.0 to 31.5, number needed to treat 2.3). After two weeks and four weeks the differences in cure rates between the two groups had become smaller. More children in the placebo group were non-compliant (12 v 5) and received extra antibiotic treatment (11 v 3), and more children in the placebo group reported adverse effects (19 v 7). Staphylococcus aureus was found in 96% of the positive cultures; no strains were resistant to fusidic acid.. Fusidic acid is much more effective than placebo (when both are given in combination with povidone-iodine shampoo) in the treatment of impetigo. Because of the low rate of cure and high rate of adverse events in the placebo group, the value of povidone-iodine in impetigo can be questioned.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Child; Child, Preschool; Double-Blind Method; Drug Therapy, Combination; Family Practice; Female; Follow-Up Studies; Fusidic Acid; Humans; Impetigo; Infant; Infant, Newborn; Logistic Models; Male; Ointments; Povidone-Iodine; Staphylococcus; Treatment Outcome

Povidone-iodine (PVP-I) is widely used in antiseptic agents. Immediate allergic reaction to PVP-I preparations is very rare and often overlooked, as it is difficult to diagnose. Polyvinylpyrrolidone (PVP) is thought to play a role in the underlying mechanism. We examined the usefulness of the histamine release test (HRT) for definite diagnosis of PVP allergy.. A 9-year-old boy with eosinophilia (1,500/microl) and elevated total IgE (1,376 IU/ml) was suspected clinically of having a PVP allergy, as he had anaphylaxis twice when he was administered a PVP-I solution for impetigo contagiosum. Skin prick tests (SPTs) were performed with a PVP-I solution, PVP (K30), gentamicin sulfate and 2 other medicines containing PVP. HRT was assessed using peripheral blood basophils.. SPTs to PVP-I solution, PVP-K30 and other medicines were all negative. Histamine release was observed on stimulation by PVP in the presence of autologous serum, although it was not observed in the absence of autologous serum.. This observation was in line with the clinical findings that anaphylaxis had not developed despite the long use of PVP-I solution, but developed only when he received PVP-I solution treatment where basophils could contact PVP-I in the presence of serum, which was probably due to a broken skin and vessel condition. Furthermore, our results suggest the usefulness of HRT in the diagnosis of PVP allergy, and the possibility that negative SPT does not entirely rule out PVP allergy.

Topics: Anaphylaxis; Anti-Infective Agents, Local; Child; Dermatitis, Atopic; Humans; Impetigo; Male; Pharmaceutic Aids; Povidone; Povidone-Iodine