A Cochrane review [Abstract] 1 included 68 studies covering 50 different treatments, with a total of 5 578 subjects. Topical antibiotics showed better cure rates than placebo (RR 2.24, 95% CI 1.61 to 3.13; 6 studies, n=575). 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; 4 studies, n=440). Topical mupirocin was slightly more effective than oral erythromycin (RR 1.07, 95% CI 1.01 to 1.13; 10 studies, n=581) for limited, non-bullous disease. 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 (RR 1.29, 95% CI 1.07 to 1.56; 2 studies, n=79), and cloxacillin (RR 1.59, 95% CI 1.21 to 2.08; 2 studies, n=166). There was lack of evidence for the benefit of using disinfectant solutions. Topical antibiotics were significantly better than disinfecting treatments (RR 1.15, 95% CI 1.01 to 1.32; 2 studies, n=292).
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.
Comment:Resistance patterns of staphylococci - which causes impetigo - change over time and resistance between regions and countries may vary considerably. Thus, up-to-date, local characteristics and resistance patterns of the causative bacteria should always be taken into account when choosing antibiotic treatment. In addition, health authorities and other relevant bodies may advise against prescribing certain antibiotics for impetigo, in order to restrict the development of bacterial resistance and reserve these drugs for more serious infections.
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