[en] Impetigo is a superficial bacterial infection of the skin. It is a contagious condition particularly affecting children. In many instances, a topical antibacterial treatment is recommended to clear the disease. Topical antibiotics and antiseptics can be used, but the risk for antibiotic-induced bacterial resistance of the community-acquired type has been pointed out. The present study was undertaken as a randomized intraindividual comparative trial between fusidic acid (FA) cream and povidone iodine (PVP-I) gel in 40 children suffering from impetigo. Cultures revealed Staphylococcus aureus in the vast majority of the cases. The lesions present on each upper limb were treated twice daily with one or the other test formulation. Clinical assessments were performed twice weekly until cure. After one week, cure was obtained in 57.5% of the PVP-I-treated limbs compared to 32.5% of the FA-treated limbs. At the end of treatment cure was obtained first on the PVP-I treated sites in 67.5% of cases compared to 15% on the FA-treated sites. Clinical cure occurred simultaneously on both test sites in 17.5% of cases. In conclusion, PVP-I provided faster clinical cure than FA. Considering the treatment cost, the raising community-acquired staphylococci resistance to FA, and the results of the present study, PVP-I gel appears superior to FA cream in childhood impetigo.
Disciplines :
Dermatology
Author, co-author :
Szepetiuk, Gregory; Centre Hospitalier Universitaire de Liège - CHU > Dermatopathologie
Henry, Frédérique ; Centre Hospitalier Universitaire de Liège - CHU > Dermatopathologie
Pierard, Gérald ; Centre Hospitalier Universitaire de Liège - CHU > Dermatopathologie
Language :
English
Title :
Comparative study of the efficacy of fusidic acid and povidone iodine in childhood impetigo.
M. Rajagopalan, G. Pallavi, S. Verhese and T. Menon, Bacteriological etiology of impetigo, J Commun Dis 36 (2004), 212-213.
K. Iwatsuki, O.Yamasaki, S. Morizane and T. Oono, Staphylococcal cutaneous infections: invasion, evasion and aggression, J Dermatol Sci 42 (2006), 203-214.
S. Koning, R.S. Mohammedamin, J.C. van der Wouden, L.W. van Suijlekom-Smit, F.G. Schellevis and S. Thomas, Impetigo:incidence and treatment in Dutch general practice in 1987 and 2001-results from two national surveys, Br J Dermatol 154 (2006), 239-243.
S. Koning, L.W. Van Suijlekom-Smit, J.L. Nouwen et al., Fusidic acid cream in the treatment of impetigo in general practice: double blind randomised placebo controlled trial, Br Med J 324 (2001), 203-206.
F. Henry, L. Thirion, C. Piérard-Franchimont and G.E. Piérard, Les antibiotiques topiques en Europe: resistances insulaires et indifference continentale? Dermatol Actual 92 (2005), 4-10 (in Belgian).
A.C. Gales, S.S. Andrade, H.S. Sader and R.N. Jones, Activity of mupirocin and 14 additional antibiotics against staphylococci isolated from Latin American hospitals: report from the SENTRY antimicrobial surveillance program, J Chemother 16 (2004), 323-328.
I.B. Gosbell, Methicillin-resistant Staphylococcus aureus: impact on dermatology practice, Am J Clin Dermatol 5 (2004), 239-259.
W.Witte, C. Cuny, B. Strommenger et al., Emergence of a new community acquired MRSA strain in Germany, Euro Surveill 9 (2004), 16-18.
N. Noguchi, H. Nakaminami, S. Nishijima, I. Kurokawa, H. So and M. Sasatsu, Antimicrobial agent of susceptibilities and antiseptic resistance gene distribution among methicillinresistant Staphylococcus aureus isolates from patients with impetigo and staphylococcal scalded skin syndrome, J Clin Micribol 44 (2006), 2119-2125.
D. Livermore, Fusidic-acid use and resistance, Lancet 360 (2002), 806.
O. Sule, N. Brown, D.F. Brown and N. Burrows, Judicious use is advisable, Br Med J 324 (2002), 1394.
S.E. Owen and J.S. Cheesbrough, Fusidic acid cream for impetigo. Findings cannot be extrapolated, Br Med J 324 (2002), 1394.
V.C.Weston, T.C. Boswell, R.G. Finch andW. Perkins, Fusidic acid cream for impetigo. Emergence of resistance to fusidic acid limits its use, Br Med J 324 (2002), 1394.
B. Stoddart, T. Collyns and M. Denton, Fusidic acid cream for impetigo. Problem may be clinically important, Br Med J 324 (2002), 1394.
E.M. Brown and R. Wise, Fusidic acid cream for impetigo. Fusidic acid should be used with restraint, Br Med J 324 (2002), 1394.
P. Zadik and N. Young, Fusidic acid cream for impetigo. Resistance trend must be monitored, Br Med J 324 (2002), 1394.
J.C. Ravenscroft, A. Layton and M. Barnham, Observations on high levels of fusidic acid resistant Staphylococcus aureus in Harrogate, North Yorkshire, UK, Clin Exp Dermatol 25 (2000), 327-330.
A. Osterlund, T. Edén, B. Olsson-Liljequist, S. Haeggman and G. Kahlmeter, Swedish Study Group on Fusidic Acid-resistant Staphylococcal aureus. Clonal spread among Swedish children of a Staphylococcus aureus strain resistant to fusidic acid, Scand J Infect Dis 34 (2002), 729-734.
Y. Tveten, A. Jenkins and B.E. Kristiansen, A fusidic acidresistant clone of Staphylococcus aureus associated with impetigo bullosa is spreading in Norway, J Antimicrob Chemother 50 (2002), 873-876.
J.E. Afset and J.A. Maeland, Susceptibility of skin and softtissue isolates of Staphylococcus aureus and Streptococcus pyogenes to topical antibiotics: indications of clonal spread of fusidic acid-resistant Staphylococcus aureus, Scand J Infect Dis 35 (2003), 84-89.
S. Rortveit and G. Rortveit, An epidemic of bullous impetigo in the municipality of Austevoll in the year 2002, Tidsskr Nor Laegeforen 123 (2003), 2557-2560 (in Norwegian).
M. Shah and M. Mohanraj, High levels of fusidic acid-resistant Staphylococcus aureus in dermatology patients, Br J Dermatol 148 (2003), 1018-1020.
D. Dobie and J. Gray, Fusidic acid resistance in Staphylococcus aureus, Arch Dis Child 89 (2004), 74-77.
D. El-Zimaity, A.M. Kearns, S.J. Dawson, S. Price and G.A. Harrison, Survey, characterization and susceptibility to fusidic acid of Staphylococcus aureus in the Carmarthen area, J Antimicrob Chemother 54 (2004), 441-446.
A.J. O’Neill, A.R. Larsen, A.S. Henriksen and I. Chopra, A fusidic acid-resistant epidemic strain of Staphylococcus aureus carries the fusB determinant, whereas fus A mutations are prevalent in other resistant isolates, Antimicrob Agents Chemother 48 (2004), 3594-3597.
B.W. Mason and A.J. Howard, Fusidic acid resistance in community isolates of methicillin susceptible Staphylococcus aureus and the use of topical fusidic acid: a retrospective casecontrol study, Int J Antimicrob Agents 23 (2004), 300-303.
A. Osterlund, G. Kahlmeter, S. Haeggman and B. Olsson-Liljequist, Swedish Study Group on Fusidic Acid Resistant Staphylococcal aureus. Staphylococcus aureus resistant to fusidic acid among Swedish children: a follow-up study, Scand J Infect Dis 38 (2006), 334-344.
A.R. McLure and J. Gordon, In-vitro evaluation of povidoneiodine and chlorhexidine against methicillin-resistant Staphylococcus aureus, J Hosp Infect 21 (1992), 291-299.
P.D. Goldenheim, In vitro efficacy of povidone-iodine solution and cream against methicillin-resistant Staphylococcus aureus, Postgrad Med J 69(Suppl 3) (1993), S62-S65.
T.Yasuda, S.Yoshimura, Y. Katsuno et al., Comparison of bactericidal activities of various disinfectants against methicillinsensitive Staphylococcus aureus and methicillin-resistant Staphylococcus aureus, Postgrad Med J 69(Suppl 3) (1993), S66-S69.
D. Michel and G.A. Zäch, Antiseptic efficacy of disinfecting solution in suspension test in vitro against methicillinresistant Staphylococcus aureus, Pseudomonas aeruginosa and Escherichia coli in pressure sore wounds after spinal cord injury, Dermatology 195(Suppl 2) (1997), 36-41.
C. Block, E. Robenshtok, A. Simhon and M. Shapiro, Evaluation of chlorhexidine and povidone iodine activity against methicillin-resistant Staphylococcus aureus and vancomycinresistant Enterococcus faecalis using a surface test, J Hosp Infect 46 (2000), 147-152.
C. Flagothier, E. Uhoda, V. Goffin, C. Piérard-Fanchimont and G.E. Piérard, Biocénose cutanée, peptides antimicroboiens cutanés et antiseptiques, Dermatol Actual 86 (2004), 22-24 (in Belgian).
T. Kunisada, K. Yamada, S. Oda and O. Hara, Investigation on the efficacy of povidone-iodine against antiseptic-resistant species, Dermatology 195(Suppl 2) (1997), 14-18.
M. Gilbert, Topical 2% mupirocin versus 2% fusidic acid ointment in the treatment of primary and secondary skin infections, J Am Acad Dermatol 20 (1989), 1083-1087.
P.M. Mertz, D.A. Marshall, W.H. Eaglstein, Y. Piovanetti and J. Montalvo, Topical mupirocin treatment of impetigo is equal to oral erythromycin therapy, Arch Dermatol 125 (1989), 1069-1073.
J.W. Bass, D.S. Chan, K.M. Creamer et al., Comparison of oral cephalexin, topical mupirocin and topical bacitracin for treatment of impetigo, Pediatr Inf Dis J 16 (1997), 708-710.
J.W. Britton, J.E. Fajardo and B. Krafte-Jacobs, Comparison of mupirocin and erythromycin in the treatment of impetigo, J Pediatr 117 (1990), 827-829.
R. Dagan and Y. Bar-David, Double-blind study comparing erythromycin and mupirocin for treatment of impetigo in children:implications of a high prevalence of erythromycinresistant Staphylococcus aureus strains, Antimicrob Agents Chemother 36 (1992), 287-290.
A. George and G. Rubin, A systematic review and metaanalysis of treatments for impetigo, Br J Gen Pract 53 (2003), 480-487.
E. Brown and R.Wise, Treatment for impetigo, Br J Gen Pract 53 (2003), 974.