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Ramireddy AR, Behara DK. QbD Based Formulation Development and Optimisation of Ozenoxacin Topical Nano-Emulgel and Efficacy Evaluation Using Impetigo Mice Model. AAPS PharmSciTech 2024; 25:90. [PMID: 38649513 DOI: 10.1208/s12249-024-02805-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/09/2024] [Indexed: 04/25/2024] Open
Abstract
To formulate and optimize Ozenoxacin nano-emulsion using Quality by Design (QbD) concept by means of Box-Behnken Design (BBD) and converting it to a gel to form Ozenoxacin nano-emulgel followed by physico-chemical, in-vitro, ex-vivo and in-vivo evaluation. This study demonstrates the application of QbD methodology for the development and optimization of an effective topical nanoemulgel formulation for the treatment of Impetigo focusing on the selection of appropriate excipients, optimization of formulation and process variables, and characterization of critical quality attributes. BBD was used to study the effect of "% of oil, % of Smix and homogenization speed" on critical quality attributes "globule size and % entrapment efficiency" for the optimisation of Ozenoxacin Nano-emulsion. Ozenoxacin loaded nano-emulgel was characterized for "description, identification, pH, specific gravity, amplitude sweep, viscosity, assay, organic impurities, antimicrobial effectiveness testing, in-vitro release testing, ex-vivo permeation testing, skin retention and in-vivo anti-bacterial activity". In-vitro release and ex-vivo permeation, skin retention and in-vivo anti-bacterial activity were found to be significantly (p < 0.01) higher for the nano-emulgel formulation compared to the innovator formulation (OZANEX™). Antimicrobial effectiveness testing was performed and found that even at 70% label claim of benzoic acid is effective to inhibit microbial growth in the drug product. The systematic application of QbD principles facilitated the successful development and optimization of a Ozenoxacin Nano-Emulsion. Optimised Ozenoxacin Nano-Emulgel can be considered as an effective alternative and found to be stable at least for 6 months at 40 °C / 75% RH and 30 °C / 75% RH.
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Affiliation(s)
- Amarnath Reddy Ramireddy
- Department of Pharmaceutical Sciences, Jawaharlal Nehru Technological University Anantapur (JNTUA), Ananthapuramu, Andhra Pradesh, 515002, India.
| | - Dilip Kumar Behara
- Chemical Engineering, JNTUA College of Engineering (Autonomous), Jawaharlal Nehru Technological University Anantapur (JNTUA), Ananthapuramu, Andhra Pradesh, 515002, India
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2
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Ni X, Liu M. Rapid remission of severe impetigo herpetiformis following combined treatment with secukinumab and corticosteroids. Eur J Dermatol 2023; 33:712-713. [PMID: 38465566 DOI: 10.1684/ejd.2023.4620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
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Wan Y, Zhang L, Xie B, Wu J, Zhao M, Guo J, Ding J. Impetigo herpetiformis in the second trimester: a case report and review of the literature. J Int Med Res 2023; 51:3000605231217950. [PMID: 38102997 PMCID: PMC10725655 DOI: 10.1177/03000605231217950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 11/14/2023] [Indexed: 12/17/2023] Open
Abstract
Impetigo herpetiformis is a rare skin disease that most often occurs in the third trimester of pregnancy. It is currently considered as a form of generalized pustular psoriasis and the typical skin lesions comprise small sterile pustules. Here, a case of impetigo herpetiformis in the second trimester of pregnancy after 7 weeks of hydroxychloroquine administration for suspected Sjogren's syndrome is reported. Treatment with anti-infective, anti-inflammatory and immunosuppressive medication did not improve the patient's condition. Following delivery of a live male by emergency caesarean section at 29 weeks' gestation, the rash was reported to be completely resolved by 3 months postpartum. Previously published cases of impetigo herpetiformis in the second trimester of pregnancy that were retrieved from a search of the PubMed database are also reviewed and discussed.
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Affiliation(s)
- Yingcai Wan
- Department of Dermatology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Lei Zhang
- Department of Dermatology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Boyu Xie
- Department of Dermatology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Jianbo Wu
- Department of Dermatology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Mengjie Zhao
- Department of Dermatology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Juanjuan Guo
- Department of Obstetrics and Gynaecology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Juan Ding
- Department of Dermatology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
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Thornley S, Sundborn G, Engelman D, Roskvist R, Pasay C, Marshall R, Long W, Dugu N, Hopoi N, Moritsuka S, McCarthy J, Morris AJ. Children's scabies survey indicates high prevalence and misdiagnosis in Auckland educational institutions. J Paediatr Child Health 2023; 59:1296-1303. [PMID: 37920140 DOI: 10.1111/jpc.16512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 10/16/2023] [Accepted: 10/19/2023] [Indexed: 11/04/2023]
Abstract
AIM Here, we present results of a survey of scabies prevalence in childcare centres and primary schools in Auckland. METHODS Children whose parents agreed to take part in participating centres in the Auckland region were examined for scabies by general practitioners and given questionnaires of relevant symptoms. Diagnoses of clinical or suspected scabies were made according to the International Alliance for the Control of Scabies (IACS) criteria. The survey was a stratified random sample of schools and early childcare centres. A quantitative polymerase chain reaction (PCR) test was also used to complement the IACS criteria. RESULTS A total of 181 children were examined, with 145 children with history information, 16 of whom (11.0%) met the criteria for 'clinical' or 'suspected' scabies. Weighted analysis, accounting for the survey design, indicated that the prevalence of scabies in early childcare centres was 13.2% (95% CI: 4.3 to 22.1), with no school-aged children fulfilling these criteria. A higher proportion had clinical signs of scabies with 23 (12.7%) having typical scabies lesions and a further 43 (23.8%) had atypical lesions. A total of 64 PCR tests were taken and 15 (23%) were positive. None of these cases were receiving treatment for scabies. Five were undergoing topical skin treatment: three with topical steroid and two with calamine lotion. CONCLUSIONS The prevalence of children with scabies is high in early childcare centres in Auckland. Misdiagnosis is suggested by several PCR positive cases being treated by topical agents used to treat other skin conditions.
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Affiliation(s)
- Simon Thornley
- Section of Epidemiology and Biostatistics, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Gerhard Sundborn
- Section of Pacific Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Daniel Engelman
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Rachel Roskvist
- Department of Primary Care, The University of Auckland, Auckland, New Zealand
| | - Cielo Pasay
- QIMR Berghoffer Medical Research Institute, Brisbane, Queensland, Australia
| | - Roger Marshall
- Section of Epidemiology and Biostatistics, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Wei Long
- Auckland Family Medical Centre, Auckland, New Zealand
| | - Noela Dugu
- Conifer Gardens Medical Centre, Auckland, New Zealand
| | | | - Shunsuke Moritsuka
- Section of Pacific Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - James McCarthy
- Doherty Institute, The University of Melbourne, Melbourne, Victoria, Australia
| | - Arthur J Morris
- LabPLUS, Auckland District Health Board, Auckland, New Zealand
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Gatto A, Capossela L, Ferretti S, Di Sarno L, Oliveti A, Talamonti D, Curatola A, Chiaretti A, Fiori B. Single-center, prospective, and observational study on the management and treatment of impetigo in a pediatric population. Eur Rev Med Pharmacol Sci 2023; 27:9273-9278. [PMID: 37843341 DOI: 10.26355/eurrev_202310_33955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
OBJECTIVE Ozenoxacin is a new antibiotic used to treat non-bullous impetigo. The aim of this study is to evaluate the microbiological and clinical efficacy of topical ozenoxacin 1% cream after 5-day twice-daily treatment, in pediatric patients with impetigo. PATIENTS AND METHODS This observational and prospective study included patients aged 6 months to 18 years, with non-bullous impetigo. Efficacy was measured using the Skin Infection Rating Scale (SIRS) and microbiological culture at the first visit (T0), at the second visit after 72 hours (T1) and after 5 days (T2). Safety and tolerability were also evaluated. RESULTS A total of 50 patients was enrolled. A reduction of SIRS score >10% after 72 hours of treatment was noticed in all patients, while a complete reduction was assessed after 5 days in all the population. Microbiologic success rates for ozenoxacin at T1 was 92% (four patients had original pathogens in the specimen culture from the skin area), whereas at T2, it was 100%. CONCLUSIONS Topical ozenoxacin has strong efficacy in treating impetigo in pediatric patients. Ozenoxacin's clinical and microbiological rapid onset of response led to consider this antibiotic a novel efficacy option for the treatment of impetigo.
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Affiliation(s)
- A Gatto
- Institute of Pediatrics, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy.
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Heal C. Feasibility Study for Randomised Control Tiral for Topical Treatment of Impetigo in Australian General Practice. Clinical trial 2023. [PMID: 37023250 DOI: 10.1370/afm.21.s1.4047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Context Impetigo affects millions of children worldwide. Most guidelines recommend antibiotics as first-line treatment however topical antiseptics present a potentially valuable, understudied, antibiotic-sparing treatment for mild impetigo. Objective We aimed to determine the feasibility of a randomized controlled trial (RCT) comparing efficacy of soft white paraffin (SWP), hydrogen peroxide (H2O2) and mupirocin for mild impetigo. Study Design The study was designed in keeping with the SPIRIT statement and designed in accordance with the CONSORT statement for pilot RCTs Setting, population studied Consecutive patients presenting with mild impetigo were recruited from two private general practices in North Queensland, Australia. Intervention: Participants were randomly assigned to one of three treatments: soft white paraffin (SWP), hydrogen peroxide (H2O2) and mupirocin ointment. Outcome measures: Size and number of lesions were measured at the initial consultation and day six. Post-recruitment, interviews with General Practitioners were transcribed and themes identified to determine protocol acceptability, recruitment barriers and avenues to improve delivery. Results Two participants received SWP (n=1) and mupirocin (n=1). Both commenced oral antibiotics following failure of topical treatment. Recruitment barriers included reduced presentation of impetigo due to COVID-19, pre-treatment with existing at-home medications and moderate/severe infection. Childcare centers and pharmacies were identified as alternative venues to improve recruitment rate. Conclusions Valuable insight was gained into the practicality of conducting a RCT of impetigo treatments in general practice. Future trials should consider recruiting outside of general practice clinics to capture patients at earlier, more mild stages of infection. Further investigation into the prevalence and impact of use of at-home expired antibiotics may be beneficial.
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Vendrik KEW, Kuijper EJ, Dimmendaal M, Silvis W, Denie-Verhaegh E, de Boer A, Postma B, Schoffelen AF, Ruijs WLM, Koene FMHPA, Petrignani M, Hooiveld M, Witteveen S, Schouls LM, Notermans DW. An unusual outbreak in the Netherlands: community-onset impetigo caused by a meticillin-resistant Staphylococcus aureus with additional resistance to fusidic acid, June 2018 to January 2020. Euro Surveill 2022; 27:2200245. [PMID: 36695440 PMCID: PMC9732922 DOI: 10.2807/1560-7917.es.2022.27.49.2200245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 08/15/2022] [Indexed: 12/14/2022] Open
Abstract
In this retrospective observational study, we analysed a community outbreak of impetigo with meticillin-resistant Staphylococcus aureus (MRSA), with additional resistance to fusidic acid (first-line treatment). The outbreak occurred between June 2018 and January 2020 in the eastern part of the Netherlands with an epidemiological link to three cases from the north-western part. Forty nine impetigo cases and eight carrier cases were identified, including 47 children. All but one impetigo case had community-onset of symptoms. Pharmacy prescription data for topical mupirocin and fusidic acid and GP questionnaires suggested an underestimated outbreak size. The 57 outbreak isolates were identified by the Dutch MRSA surveillance as MLVA-type MT4627 and sequence type 121, previously reported only once in 2014. Next-generation sequencing revealed they contained a fusidic acid resistance gene, exfoliative toxin genes and an epidermal cell differentiation inhibitor gene. Whole-genome multilocus sequence typing revealed genetic clustering of all 19 sequenced isolates from the outbreak region and isolates from the three north-western cases. The allelic distances between these Dutch isolates and international isolates were high. This outbreak shows the appearance of community-onset MRSA strains with additional drug resistance and virulence factors in a country with a low prevalence of antimicrobial resistance.
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Affiliation(s)
- Karuna E W Vendrik
- Leiden University Medical Center, Leiden, the Netherlands
- National Institute for Public Health and the Environment (Rijksinstituut voor Volksgezondheid en Milieu, RIVM), Bilthoven, the Netherlands
| | - Ed J Kuijper
- Leiden University Medical Center, Leiden, the Netherlands
- National Institute for Public Health and the Environment (Rijksinstituut voor Volksgezondheid en Milieu, RIVM), Bilthoven, the Netherlands
| | - Marieke Dimmendaal
- Municipal health service North and East Gelderland, Warnsveld, The Netherlands
| | - Welmoed Silvis
- Laboratory for Medical Microbiology and Public Health (LabMicTA), Hengelo, The Netherlands
| | | | | | - Bent Postma
- Slingeland Hospital, Doetinchem, The Netherlands
| | - Annelot F Schoffelen
- National Institute for Public Health and the Environment (Rijksinstituut voor Volksgezondheid en Milieu, RIVM), Bilthoven, the Netherlands
| | - Wilhelmina L M Ruijs
- National Institute for Public Health and the Environment (Rijksinstituut voor Volksgezondheid en Milieu, RIVM), Bilthoven, the Netherlands
| | - Fleur M H P A Koene
- Medical Laboratory Services, Willemstad, Curacao
- Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | | | | | - Sandra Witteveen
- National Institute for Public Health and the Environment (Rijksinstituut voor Volksgezondheid en Milieu, RIVM), Bilthoven, the Netherlands
| | - Leo M Schouls
- National Institute for Public Health and the Environment (Rijksinstituut voor Volksgezondheid en Milieu, RIVM), Bilthoven, the Netherlands
| | - Daan W Notermans
- National Institute for Public Health and the Environment (Rijksinstituut voor Volksgezondheid en Milieu, RIVM), Bilthoven, the Netherlands
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Xie F, Johnson EF, Cantwell HM. Disseminated Bullous Impetigo in an Adult With Atopic Dermatitis Flare. Mayo Clin Proc 2022; 97:2097-2098. [PMID: 36333016 DOI: 10.1016/j.mayocp.2022.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 06/21/2022] [Accepted: 06/27/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Fangyi Xie
- Department of Dermatology, Mayo Clinic, Rochester, MN
| | - Emma F Johnson
- Department of Dermatology, Mayo Clinic, Rochester, MN; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
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Khan RMA, Muzammil A, Siddiqi S, Qasim SM, Nadeem A. Scabies Surrepticius (Bullous Scabies) Presenting as Bullous Impetigo in a Child. J Coll Physicians Surg Pak 2022; 32:380-382. [PMID: 35148595 DOI: 10.29271/jcpsp.2022.03.380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 03/02/2020] [Indexed: 06/14/2023]
Abstract
Bullous scabies (BS) is a rare and atypical presentation of scabies, usually affecting elderly males during the seventh decade of life. BS is characterised by intense pruritic eruptions, nocturnal itch, and characteristic blisters with or without burrows in scabies-prone areas. The scabies lesions might predispose patients to bacterial super-infections, resulting in bullae formation similar to bullous impetigo. The diagnosis of BS is often puzzling and delayed. Few cases of BS have been reported among children globally. We, herein, report a case of BS in an eight-year boy from Pakistan, treated successfully with 5% topical permethrin and 2% mupirocin. Complete healing was noted within four weeks with no recurrence at two months follow-up. Key Words: Scabies, Bullous, Child, Diagnosis, Treatment.
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Affiliation(s)
- Rao Muhammad Abid Khan
- Department of Microbiology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan
| | - Asma Muzammil
- Department of Dermatology, Dr. Ruth K.M. Pfau Civil Hospital, Karachi, Pakistan
| | - Sualleha Siddiqi
- Department of Microbiology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan
| | - Shazia Muhammad Qasim
- Department of Molecular Biology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan
| | - Ali Nadeem
- Department of Microbiology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan
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Chamli A, Zaouak A, Hammami H. Genital Bullous Impetigo in a Child. Indian Pediatr 2021; 58:1104. [PMID: 34837377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Amal Chamli
- Dermatology Department, Habib Thameur Hospital, Tunis, Tunisia and University of Tunis El Manar, Faculty of Medicine of Tunis, Tunisia.
| | - Anissa Zaouak
- Dermatology Department, Habib Thameur Hospital, Tunis, Tunisia and University of Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Houda Hammami
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunisia and Habib Thameur Hospital, Research Unit 'Genodermatoses and Cancers' LR12SP03
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Brazel M, Desai A, Are A, Motaparthi K. Staphylococcal Scalded Skin Syndrome and Bullous Impetigo. Medicina (Kaunas) 2021; 57:medicina57111157. [PMID: 34833375 PMCID: PMC8623226 DOI: 10.3390/medicina57111157] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/18/2021] [Accepted: 10/20/2021] [Indexed: 12/21/2022]
Abstract
Staphylococcal scalded skin syndrome (SSSS) and bullous impetigo are infections caused by Staphylococcus aureus. The pathogenesis of both conditions centers around exotoxin mediated cleavage of desmoglein-1, which results in intraepidermal desquamation. Bullous impetigo is due to the local release of these toxins and thus, often presents with localized skin findings, whereas SSSS is from the systemic spread of these toxins, resulting in a more generalized rash and severe presentation. Both conditions are treated with antibiotics that target S. aureus. These conditions can sometimes be confused with other conditions that result in superficial blistering; the distinguishing features are outlined below.
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Affiliation(s)
- Morgan Brazel
- University of Florida College of Medicine, Gainesville, FL 32610, USA; (M.B.); (A.A.)
| | - Anand Desai
- Department of Dermatology, University of Florida College of Medicine, Gainesville, FL 32610, USA;
| | - Abhirup Are
- University of Florida College of Medicine, Gainesville, FL 32610, USA; (M.B.); (A.A.)
| | - Kiran Motaparthi
- Department of Dermatology, University of Florida College of Medicine, Gainesville, FL 32610, USA;
- Correspondence:
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Schachner LA, Lynde CW, Kircik LH, Torrelo A, Hohl D, Kwong P, Oza V, Andriessen A, Hebert AA. Treatment of Impetigo and Antimicrobial Resistance. J Drugs Dermatol 2021; 20:366-372. [PMID: 33852242 DOI: 10.36849/jdd.2021.5795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Impetigo is a contagious bacterial infection that affects the superficial skin layers. Increasing worldwide antimicrobial resistance (AMR) to existing topical agents commonly prescribed to treat impetigo is central to treatment failure. The Worldwide Health Organization developed a global action plan on AMR, but omitted information about AMR stewardship programs for topical antibiotics. OBJECTIVES The review aims to provide information to clinicians and stakeholders regarding AMR and antimicrobial stewardship on topical antimicrobial drugs for impetigo treatment. METHODS The literature searches reviewed the status of AMR to current topical antibiotics in impetigo, current therapeutic behavior, and concordance with antimicrobial stewardship principles. Two international panels convened to discuss the output of the searches, and the results of the panel discussions were used in the development of the manuscript. RESULTS The literature search included clinical trials, research studies, clinical guidelines, consensus papers, and reviews (if they provided original data), published between January 2008 and May 2019. The articles were selected based on clinical relevancy of impetigo management, clinical efficacy, and safety of the treatment and antimicrobial resistance. The searches resulted in one-hundred and ninety-eight articles. After applying the eligibility criteria, nineteen articles met inclusion criteria and were considered in the present review. CONCLUSIONS While published antimicrobial stewardship guidelines have focused on systemic antibiotics, few studies have attempted to evaluate topical antibiotic prescribing practices for impetigo treatment. Many of the topical impetigo treatments currently in use have developed resistance. The appropriate use of topical ozenoxacin can help eradicate impetigo while minimizing AMR.J Drugs Dermatol. 20(4):366-372. doi:10.36849/JDD.5795.
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Abstract
This evidence-based review highlights cutaneous infections of bacterial, viral, and fungal origin that are frequently encountered by clinicians in all fields of practice. With a focus on treatment options and management, the scope of this article is to serve as a reference for physicians, regardless of field of specialty, as they encounter these pathogens in clinical practice.
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Affiliation(s)
- Ana Preda-Naumescu
- School of Medicine, University of Alabama at Birmingham, 1670 University Blvd, Birmingham, AL 35233, USA
| | - Boni Elewski
- Department of Dermatology, University of Alabama at Birmingham, 510 20th Street South, FOT Suite 858, Birmingham, AL 35233, USA
| | - Tiffany T Mayo
- Department of Dermatology, University of Alabama at Birmingham, 510 20th Street South, FOT Suite 858, Birmingham, AL 35233, USA.
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14
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Elbæk MV, Beck S, Jemec G. [Bulløs impetigo - udbredt læsion hos en immunsupprimeret patient]. Ugeskr Laeger 2021; 183:V71058. [PMID: 34060469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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15
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Behera P, Munshi H, Kalkonde Y, Deshmukh M, Bang A. Control of scabies in a tribal community using mass screening and treatment with oral ivermectin -A cluster randomized controlled trial in Gadchiroli, India. PLoS Negl Trop Dis 2021; 15:e0009330. [PMID: 33861741 PMCID: PMC8081337 DOI: 10.1371/journal.pntd.0009330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 04/28/2021] [Accepted: 03/25/2021] [Indexed: 11/18/2022] Open
Abstract
Background Scabies is often endemic in tribal communities and difficult to control. We assessed the efficacy of a community-based intervention using mass screening and treatment with oral ivermectin in controlling scabies. Methods/ Findings In this cluster randomised controlled trial, 12 villages were randomly selected from a cluster of 42 tribal villages in Gadchiroli district. In these villages, trained community health workers (CHWs) conducted mass screening for scabies. The diagnosis was confirmed by a physician. Six villages each were randomly allocated to the intervention and usual care arm (control arm). In the intervention arm (population 1184) CHWs provided directly observed oral ivermectin to scabies cases and their household contacts. In the usual care arm (population 1567) scabies cases were referred to the nearest clinic for topical treatment as per the standard practice. The primary outcome was prevalence of scabies two months after the treatment. Secondary outcomes were prevalence of scabies after twelve months of treatment and prevalence of impetigo after two and twelve months of treatment. Outcomes were measured by the team in a similar way as the baseline. The trial was registered with the clinical trial registry of India, number CTRI/2017/01/007704. In the baseline, 2 months and 12 months assessments 92.4%, 96% and 94% of the eligible individuals were screened in intervention villages and 91.4%, 91.3% and 95% in the usual care villages. The prevalence of scabies in the intervention and usual care arm was 8.4% vs 8.1% at the baseline, 2.8% vs 8.8% at two months [adjusted relative risk (ARR) 0.21, 95% CI 0.11–0.38] and 7.3% vs 14.1% (ARR 0.49, 95% CI 0.25–0.98) at twelve months The prevalence of impetigo in the intervention and usual care arm was 1.7% vs 0.6% at baseline, 0.6% vs 1% at two months (ARR 0.55, 95% CI 0.22–1.37) and 0.3% vs 0.7% at 12 months (ARR 0.42, 95% CI 0.06–2.74). Adverse effects due to ivermectin occurred in 12.1% of patients and were mild. Conclusions Mass screening and treatment in the community with oral ivermectin delivered by the CHWs is superior to mass screening followed by usual care involving referral to clinic for topical treatment in controlling scabies in this tribal community in Gadchiroli. Scabies is a skin infestation caused by a mite. It leads to disabling itching and sometimes serious bacterial infections. Scabies is endemic in tribal communities. Skin creams and lotions are available to treat scabies but patients may not apply them thoroughly. We conducted a controlled trial in 12 villages to test if an oral medicine called Ivermectin can reduce scabies in a tribal community in central India. In six randomly selected villages (control arm), trained community health workers (CHWs) screened for scabies, physician confirmed the diagnosis and referred patients to the nearest clinic for treatment with skin creams. In the remaining six villages (intervention arm) the patients of scabies and their contacts were provided supervised treatment with oral ivermectin by the CHWs after the diagnosis. Number of scabies cases were evaluated at two and twelve months after these treatments. The risk of scabies was reduced by 79% and 51% at the end of two and twelve months in villages where oral Ivermectin was used compared to villages where patients were referred to receive skin creams. Adverse reactions due to Ivermectin were mild. Screening of individuals and treating scabies with oral Ivermectin by CHWs can be a useful method to reduce scabies in tribal communities.
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Affiliation(s)
- Priyamadhaba Behera
- Society for Education Action and Research in Community Health (SEARCH), Gadchiroli, Maharashtra, India
| | - Hrishikesh Munshi
- Society for Education Action and Research in Community Health (SEARCH), Gadchiroli, Maharashtra, India
| | - Yogeshwar Kalkonde
- Society for Education Action and Research in Community Health (SEARCH), Gadchiroli, Maharashtra, India
| | - Mahesh Deshmukh
- Society for Education Action and Research in Community Health (SEARCH), Gadchiroli, Maharashtra, India
| | - Abhay Bang
- Society for Education Action and Research in Community Health (SEARCH), Gadchiroli, Maharashtra, India
- * E-mail:
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Schachner LA, Andriessen A, Benjamin LT, Claro C, Eichenfield LF, Esposito SM, Keller L, Kircik L, Kwong PC, McCuaig C. Do Antimicrobial Resistance Patterns Matter? An Algorithm for the Treatment of Patients With Impetigo. J Drugs Dermatol 2021; 20:134-142. [PMID: 33538559 DOI: 10.36849/jdd.5745] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSIONS 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
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Mitchell E, Bell S, Thean LJ, Sahukhan A, Kama M, Koroivueti A, Kaldor J, Steer A, Romani L. Community perspectives on scabies, impetigo and mass drug administration in Fiji: A qualitative study. PLoS Negl Trop Dis 2020; 14:e0008825. [PMID: 33275592 PMCID: PMC7744044 DOI: 10.1371/journal.pntd.0008825] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 12/16/2020] [Accepted: 09/14/2020] [Indexed: 12/04/2022] Open
Abstract
Scabies is endemic in Fiji and is a significant cause of morbidity. Little is known about the sociocultural beliefs and practices that affect the occurrence of scabies and impetigo, or community attitudes towards the strategy of mass drug administration that is emerging as a public health option for scabies and impetigo control in Fiji and other countries. Data were collected during semi-structured interviews with 33 community members in four locations in Fiji’s Northern Division. Thematic analysis examined participants’ lived experiences of scabies and impetigo; community knowledge and perceptions about scabies and impetigo aetiology and transmission; community-based treatment and prevention measures; and attitudes towards mass drug administration. Many indigenous Fijian (iTaukei) participants noted extensive and ongoing experience of scabies and impetigo among children in their families and communities, but only one participant of Indian descent (Indo-Fijian) identified personal childhood experience of scabies. Scabies and impetigo were perceived as diseases affecting children, impacting on school attendance and families’ quality of sleep. Awareness of scabies and impetigo was considerable, but there were major misconceptions around disease causation and transmission. Traditional remedies were preferred for scabies treatment, followed by biomedicines provided by local health centres and hospitals. Treatment of close household contacts was not prioritised. Attitudes towards mass drug administration to control scabies were mostly positive, although some concerns were noted about adverse effects and hesitation to participate in the planned scabies elimination programme. Findings from this first study to document perspectives and experiences related to scabies and impetigo and their management in the Asia Pacific region illustrate that a community-centred approach to scabies and impetigo is needed for the success of control efforts in Fiji, and most likely in other affected countries. This includes community-based health promotion messaging on the social dynamics of scabies transmission, and a campaign of education and community engagement prior to mass drug administration. Scabies is a skin disease causing discomfort from severe itchiness. It can lead to secondary bacterial infection of the skin (impetigo) that can in turn lead to systemic complications, including septicaemia, kidney disease and rheumatic heart disease. It can also cause sleep disorders and a reduced quality of life. Recently added to the World Health Organization list of neglected tropical diseases, scabies is estimated to affect 150 million people globally each year and is endemic in many Pacific Island countries, including Fiji. We aimed to increase understanding of community beliefs and practices that affect the occurrence of scabies and impetigo, and assess community attitudes towards the use of mass drug administration for scabies and impetigo control in Fiji. The impact of scabies and impetigo on participants’ quality of life included poor sleep quality, school absenteeism and social isolation, especially among children. Participants had awareness of scabies and impetigo, however, misconceptions around the cause and the ways in which these diseases were transmitted between individuals were common. Participants often reported choosing traditional medical remedies to treat scabies; treatment at health centres was mainly sought for secondary skin infections. Attitudes towards mass drug administration were positive, although some concerns regarding adverse effects were noted. Improved strategies, including a community-centred response, are needed for the success of control efforts in Fiji.
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Affiliation(s)
- Elke Mitchell
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
- * E-mail: (EM); (LR)
| | - Stephen Bell
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
- Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Li Jun Thean
- Tropical Diseases Group, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Mike Kama
- Ministry of Health and Medical Services, Suva, Fiji
| | | | - John Kaldor
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Andrew Steer
- Tropical Diseases Group, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Melbourne Children’s Global Health, Melbourne Children’s Campus, The Royal Children’s Hospital, Melbourne, Australia
| | - Lucia Romani
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
- Tropical Diseases Group, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- * E-mail: (EM); (LR)
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Eudaley S. Ozenoxacin (Xepi) for the Treatment of Impetigo. Am Fam Physician 2020; 101:760-761. [PMID: 32538600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Sarah Eudaley
- University of Tennessee Health Science Center College of Pharmacy, Knoxville, TN, USA
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19
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Affiliation(s)
- Ghislaine Young
- c/o La revue de l'infi rmière, 65, rue Camille-Desmoulins, 92442 Issy-les-Moulineaux cedex, France.
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Schachner LA, Torrelo A, Grada A, Micali G, Kwong PC, Scott GB, Benjamin L, Gonzalez ME, Andriessen A, Eberlein T, Eichenfield LF. Treatment of Impetigo in the Pediatric Population: Consensus and Future Directions. J Drugs Dermatol 2020; 19:281-290. [PMID: 32550690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Impetigo is a common contagious superficial bacterial skin infection. Treatment of localized lesions can be achieved through topical antibiotics. Oral antibiotics are reserved for extensive disease. Increasing antimicrobial resistance to existing therapies have raised concerns. Antimicrobial stewardship, achieved through the responsible use of antibiotics, is an important measure to re-duce bacterial resistance. This review highlights treatment options for impetigo and shares consensus statements to help guide the management of impetigo in the pediatric population. OBJECTIVE An expert panel of dermatologists and pediatricians convened in February 2019 to establish evidence-based consensus on the management of impetigo in the pediatric patient population. METHODS The consensus was created in accordance with the Appraisal of Guidelines, Research and Evaluation (AGREE) II instrument. Prior to the consensus meeting, a systematic literature review was conducted, with the selected literature deemed clinically relevant to the consensus statements. Statements were further refined and assessed systematically following established standards. The consensus process consisted of a modified Delphi approach. The consensus was established through a minimal 75% “agree” rate. RESULTS Thirteen consensus statements were developed addressing clinical challenges, existing treatment options and their limita-tions, and new therapeutic alternatives. CONCLUSION Bacterial resistance to antimicrobials commonly used in treating impetigo has been reported. Antimicrobial stewardship is critical to optimize patient outcomes and to prevent the development of resistance. Healthcare providers should be aware of local resistance patterns in impetigo to help guide therapy. The use of newer safe and effective topical antibiotic alternatives as a first-line treatment should be an important step in antimicrobial stewardship.J Drugs Dermatol. 2020;19(3): doi:10.36849/JDD.2020.4679.
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Heal C, Gorges H, van Driel ML, Tapley A, Davis J, Davey A, Holliday L, Ball J, Najib N, Spike N, FitzGerald K, Magin P. Antibiotic stewardship in skin infections: a cross-sectional analysis of early-career GP's management of impetigo. BMJ Open 2019; 9:e031527. [PMID: 31662391 PMCID: PMC6830714 DOI: 10.1136/bmjopen-2019-031527] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To establish the prevalence and associations of systemic antibiotic prescription for impetigo by early-career general practitioners (GPs) (GP registrars in their first 18 months in general practice). DESIGN A cross-sectional analysis of data from the Registrar Clinical Encounters in Training (ReCEnT) study. SETTING ReCEnT is an ongoing multisite cohort study of Australian registrars' in-consultation clinical practice across five Australian states. PARTICIPANTS Registrars participating in ReCEnT from 2010 to 2017. OUTCOME MEASURES Management of impetigo with systemic antibiotics. RESULTS 1741 registrars (response rate 96%) provided data from 384 731 problems identified in 246 434 consultations. Impetigo, on first presentation or follow-up, was managed in 930 (0.38%, 95% CI 0.35 to 0.40) consultations and comprised 0.24% (95% CI 0.23 to 0.26) of problems. 683 patients presented with a new diagnosis of impetigo of which 38/683 (5.6%) were not prescribed antibiotics; 239/683 (35.0%) were prescribed solely topical antibiotics; 306/683 (44.8%) solely systemic antibiotics and 100/683 (14.6%) both systemic and topical antibiotics. The most common systemic antibiotic prescribed was cephalexin (53.5%). Variables independently associated with prescription of systemic antibiotics were an inner regional (compared with major city) location (OR 1.82, 95% CI 1.06 to 3.13; p=0.028), seeking in-consultation information or advice (OR 2.17, 95% CI 1.47 to 3.23; p<0.001) and ordering pathology (OR 2.13, 95% CI 1.37 to 3.33; p=0.01). CONCLUSIONS Australian early-career GPs prescribe systemic antibiotics (the majority broad-spectrum) for a high proportion of initial impetigo presentations. Impetigo guidelines should clearly specify criteria for systemic antibiotic prescription and individual antibiotic choice. The role of non-antibiotic management and topical antiseptics needs to be explored further.
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Affiliation(s)
- Clare Heal
- School of Medicine and Dentistry, James Cook University, Mackay, Queensland, Australia
| | - Hilary Gorges
- Department of General Practice and Rural Medicine, James Cook University, Mackay, Queensland, Australia
| | - Mieke L van Driel
- Academic Discipline of General Practice, University of Queensland, Brisbane, Queensland, Australia
| | - Amanda Tapley
- NSW & ACT Research and Evaluation Unit, GP Synergy Ltd - Newcastle, Newcastle, New South Wales, Australia
- Discipline of General Practice, School of Medicine & Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Josh Davis
- Global and Tropical Health Division, Menzies School of Health Research, Casuarina, New South Wales, Australia
| | - Andrew Davey
- GP Synergy Ltd, Liverpool Westfield, New South Wales, Australia
| | - L Holliday
- The University of Newcastle, Newcastle, New South Wales, Australia
| | - Jean Ball
- Clinical Research Design and Statistics, The University of Newcastle Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Nashwa Najib
- GP Synergy Ltd, Liverpool Westfield, New South Wales, Australia
| | - Neil Spike
- Eastern Victoria General Practice Training, Melbourne, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | | | - Parker Magin
- Discipline of General Practice, University of Newcastle, Callaghan, New South Wales, Australia
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Imanishi I, Uchiyama J, Tsukui T, Hisatsune J, Ide K, Matsuzaki S, Sugai M, Nishifuji K. Therapeutic Potential of an Endolysin Derived from Kayvirus S25-3 for Staphylococcal Impetigo. Viruses 2019; 11:v11090769. [PMID: 31443379 PMCID: PMC6784202 DOI: 10.3390/v11090769] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 08/16/2019] [Accepted: 08/20/2019] [Indexed: 12/31/2022] Open
Abstract
Impetigo is a contagious skin infection predominantly caused by Staphylococcus aureus. Decontamination of S. aureus from the skin is becoming more difficult because of the emergence of antibiotic-resistant strains. Bacteriophage endolysins are less likely to invoke resistance and can eliminate the target bacteria without disturbance of the normal microflora. In this study, we investigated the therapeutic potential of a recombinant endolysin derived from kayvirus S25-3 against staphylococcal impetigo in an experimental setting. First, the recombinant S25-3 endolysin required an incubation period of over 15 minutes to exhibit efficient bactericidal effects against S. aureus. Second, topical application of the recombinant S25-3 endolysin decreased the number of intraepidermal staphylococci and the size of pustules in an experimental mouse model of impetigo. Third, treatment with the recombinant S25-3 endolysin increased the diversity of the skin microbiota in the same mice. Finally, we revealed the genus-specific bacteriolytic effect of recombinant S25-3 endolysin against staphylococci, particularly S. aureus, among human skin commensal bacteria. Therefore, topical treatment with recombinant S25-3 endolysin can be a promising disease management procedure for staphylococcal impetigo by efficient bacteriolysis of S. aureus while improving the cutaneous bacterial microflora.
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Affiliation(s)
- Ichiro Imanishi
- Laboratory of Veterinary Internal Medicine, Division of Animal Life Science, Institute of Agriculture, Graduate School, Tokyo University of Agriculture and Technology, 3-5-8 Saiwai-cho, Fuchu, Tokyo 183-8509, Japan
| | - Jumpei Uchiyama
- Laboratory of Veterinary Microbiology I, School of Veterinary Medicine, Azabu University, 1-17-71 Fuchinobe, Chuo-ku, Sagamihara, Kanagawa 252-5201, Japan
| | - Toshihiro Tsukui
- Nippon Zenyaku Kogyo Co. Ltd., 1-1 Tairanoue, Sasagawa, Asaka-machi, Koriyama, Fukushima 963-0196, Japan
| | - Junzo Hisatsune
- Department of Bacteriology, Graduate school of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan
| | - Kaori Ide
- Laboratory of Veterinary Internal Medicine, Division of Animal Life Science, Institute of Agriculture, Graduate School, Tokyo University of Agriculture and Technology, 3-5-8 Saiwai-cho, Fuchu, Tokyo 183-8509, Japan
| | - Shigenobu Matsuzaki
- Department of Ophthalmology and Visual Science, Kochi Medical School, Kochi University, 185-1 Kohasu, Oko-cho, Nankoku, Kochi 783-8505, Japan
| | - Motoyuki Sugai
- Department of Bacteriology, Graduate school of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan
| | - Koji Nishifuji
- Laboratory of Veterinary Internal Medicine, Division of Animal Life Science, Institute of Agriculture, Graduate School, Tokyo University of Agriculture and Technology, 3-5-8 Saiwai-cho, Fuchu, Tokyo 183-8509, Japan.
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Schachner L, Andriessen A, Bhatia N, Grada A, Patele D. Topical Ozenoxacin Cream 1% for Impetigo: A Review. J Drugs Dermatol 2019; 18:655-661. [PMID: 31334625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background: Impetigo, a bacterial infection that is highly contagious, involves the superficial skin. Topical treatment for impetigo includes amongst other bacitracin, gentamycin, mupirocin, retapamulin, and more recently, ozenoxacin 1% cream. For more severe conditions systemic antibiotics are prescribed and may be combined with a topical treatment. The current review explored the challenges in treating impetigo in pediatric and adult populations and examined the role of ozenoxacin 1% cream as a safe and effective treatment option. Methods: We performed PubMed and Google Scholar searches of the English-language literature (2010-2018) using the terms impetigo, bullous impetigo, non-bullous impetigo, antimicrobial and antibiotic resistance, mupirocin, retapamulin, and ozenoxacin. The selected publications were manually reviewed for additional resources. Results: Although guidelines were updated regularly, the recommended treatments have not changed much since 2014. Emerging antimicrobial resistance is a growing concern in dermatology and pediatrics. Impetigo therapy choices should consider the resistance pattern of S. aureus. Ozenoxacin 1% cream is a prescription medicine for topical treatment of impetigo in adults and children 2 months or older. Ozenoxacin has a low probability of selecting spontaneous resistant mutants in quinolone-susceptible or quinolone-resistant bacterial strains and has shown to be active against MRSA isolates. Ozenoxacin 1% cream has potent bactericidal activity and was shown to be effective and safe for the treatment of impetigo in two well-controlled Phase 3 trials. Conclusions: Resistance patterns in a wide range of pathogens against oral or topical antibiotics and antiseptics used for the treatment of dermatological conditions, such as impetigo have been observed. When making treatment decisions for impetigo MRSA and other antimicrobial resistance has to be taken into account. Ozenoxacin 1% cream offers a potent bactericidal activity and has demonstrated clinical efficacy and safety. Combined with its favorable features, such as a low dosing frequency and a 5 days treatment regimen, ozenoxacin 1% cream is an important option for the treatment of impetigo for pediatric and adult populations. J Drugs Dermatol. 2019;18(7):655-661.
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Romani L, Marks M, Sokana O, Nasi T, Kamoriki B, Cordell B, Wand H, Whitfeld MJ, Engelman D, Solomon AW, Kaldor JM, Steer AC. Efficacy of mass drug administration with ivermectin for control of scabies and impetigo, with coadministration of azithromycin: a single-arm community intervention trial. Lancet Infect Dis 2019; 19:510-518. [PMID: 30956111 PMCID: PMC6483975 DOI: 10.1016/s1473-3099(18)30790-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 11/08/2018] [Accepted: 12/10/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND In small community-based trials, mass drug administration of ivermectin has been shown to substantially decrease the prevalence of both scabies and secondary impetigo; however, their effect at large scale is untested. Additionally, combined mass administration of drugs for two or more neglected diseases has potential practical advantages, but efficacy of potential combinations should be confirmed. METHODS The azithromycin ivermectin mass drug administration (AIM) trial was a prospective, single-arm, before-and-after, community intervention study to assess the efficacy of mass drug administration of ivermectin for scabies and impetigo, with coadministration of azithromycin for trachoma. Mass drug administration was offered to the entire population of Choiseul Province, Solomon Islands, and of this population we randomly selected two sets of ten sentinel villages for monitoring, one at baseline and the other at 12 months. Participants were offered a single dose of 20 mg/kg azithromycin, using weight-based bands. Children weighing less than 12·5 kg received azithromycin oral suspension (20 mg/kg), and infants younger than 6 months received topical 1% tetracycline ointment. For ivermectin, participants were offered two doses of oral ivermectin 200 μg/kg 7-14 days apart using weight-based bands, or 5% permethrin cream 7-14 days apart if ivermectin was contraindicated. Our study had the primary outcomes of safety and feasibility of large-scale mass coadministration of oral ivermectin and azithromycin, which have been previously reported. We report here the prevalence of scabies and impetigo in residents of the ten baseline villages compared with those in the ten 12-month villages, as measured by examination of the skin, which was a secondary outcome of the trial. Further outcomes were comparison of the number of all-cause outpatient attendances at government clinics in Choiseul Province at various timepoints before and after mass drug administration. The trial was registered with the Australian and New Zealand Trials Registry (ACTRN12615001199505). FINDINGS During September, 2015, over 4 weeks, 26 188 people (99·3% of the estimated population of Choiseul [n=26 372] as determined at the 2009 census) were treated. At baseline, 1399 (84·2%) of 1662 people living in the first ten villages had their skin examined, of whom 261 (18·7%) had scabies and 347 (24·8%) had impetigo. At 12 months after mass drug administration, 1261 (77·6%) of 1625 people in the second set of ten villages had their skin examined, of whom 29 (2·3%) had scabies (relative reduction 88%, 95% CI 76·5-99·3) and 81 (6·4%) had impetigo (relative reduction 74%, 63·4-84·7). In the 3 months after mass drug administration, 10 614 attended outpatient clinics for any reason compared with 16 602 in the 3 months before administration (decrease of 36·1%, 95% CI 34·7-37·6), and during this period attendance for skin sores, boils, and abscesses decreased by 50·9% (95% CI 48·6-53·1). INTERPRETATION Ivermectin-based mass drug administration can be scaled to a population of over 25 000 with high efficacy and this level of efficacy can be achieved when mass drug administration for scabies is integrated with mass drug administration of azithromycin for trachoma. These findings will contribute to development of population-level control strategies. Further research is needed to assess durability and scalability of mass drug administration in larger, non-island populations, and to assess its effect on the severe bacterial complications of scabies. FUNDING International Trachoma Initiative, Murdoch Children's Research Institute, Scobie and Claire Mackinnon Trust, and the Wellcome Trust.
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Affiliation(s)
- Lucia Romani
- The Kirby Institute, UNSW, Sydney, NSW, Australia; Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK; Hospital for Tropical Diseases, London, UK
| | - Oliver Sokana
- Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Titus Nasi
- Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Bakaai Kamoriki
- Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Billie Cordell
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Handan Wand
- The Kirby Institute, UNSW, Sydney, NSW, Australia
| | | | - Daniel Engelman
- Murdoch Children's Research Institute, Melbourne, VIC, Australia; Centre for International Child Health, University of Melbourne, Melbourne, VIC, Australia
| | - Anthony W Solomon
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK; Hospital for Tropical Diseases, London, UK
| | | | - Andrew C Steer
- Murdoch Children's Research Institute, Melbourne, VIC, Australia; Centre for International Child Health, University of Melbourne, Melbourne, VIC, Australia.
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Ozenoxacin 1% cream (Xepi) for impetigo. Med Lett Drugs Ther 2019; 61:63-4. [PMID: 31169810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Sahu JK, Mishra AK. Ozenoxacin: A Novel Drug Discovery for the Treatment of Impetigo. Curr Drug Discov Technol 2019; 16:259-264. [PMID: 29732990 DOI: 10.2174/1570163815666180502165014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 04/26/2018] [Accepted: 04/26/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Ozenoxacin is one of the potent quinolone antibiotics, recently approved by the United States Food and Drug Administration (USFDA) with reported pharmacology to treat the impetigo. The demand for better acting topical formulation is increasing day by day. The present review is an attempt to summarize the facts behind the chemistry and biological applications of Ozenoxacin. Mechanism of Action: This novel drug being a quinolone antibiotic compound, acts by inhibiting DNA gyrase A and topoisomerase IV and affects supercoiling, supercoil relaxation, chromosomal condensation, chromosomal decatenation and many others. Pharmacology: Ozenoxacin has demonstrated to have a bactericidal activity against organisms, such as Staphylococcus aureus and Staphylococcus pyogenes. Ozenoxacin is non-fluorinated quinolone and being developed for the other dermatological bacterial infections as well. No sign of genotoxicity was observed when tested experimentally. CONCLUSION The present review also covers the complete picture of pharmacokinetics, clinical trials, toxicity and future scope and possible avenues in this arena.
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Affiliation(s)
- Jagdish K Sahu
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, IFTM University, Moradabad - 244102, India
| | - Arun K Mishra
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, IFTM University, Moradabad - 244102, India
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Hebert AA, Albareda N, Rosen T, Torrelo A, Grimalt R, Rosenberg N, Zsolt I, Masramon X. Topical Antibacterial Agent for Treatment of Adult and Pediatric Patients With Impetigo: Pooled Analysis of Phase 3 Clinical Trials. J Drugs Dermatol 2018; 17:1051-1057. [PMID: 30365584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Ozenoxacin is a novel topical antibacterial agent with potent bactericidal activity against Gram-positive bacteria that has been developed as a 1% cream for treatment of impetigo. This article presents pooled results of pivotal clinical trials of ozenoxacin with the objective of evaluating the efficacy, safety, and tolerability of ozenoxacin 1% cream after twice-daily topical treatment for 5 days in patients with impetigo. A pooled analysis was performed of individual patient data from two multicenter, randomized, double-blind, vehicle-controlled phase 3 registration studies conducted in patients with impetigo. Both clinical trials followed a similar methodology. Patients were randomized 1:1 to ozenoxacin or vehicle. One trial included retapamulin as an internal control. Efficacy was measured using the Skin Infection Rating Scale and microbiological culture. Safety and tolerability were evaluated. Ozenoxacin demonstrated superior clinical success versus vehicle after 5 days of therapy, superior microbiological success versus vehicle after 2 days of therapy, and was safe and well-tolerated. Ozenoxacin showed superior clinical and microbiological response versus vehicle in children as young as 2 months of age, and adults, with impetigo. Clinical Trial Registration: ClinicalTrials.gov identifier: NCT01397461 and NCT02090764; European Clinical Trials Database Number: 2011-003032-31 and 2014-000228-52. J Drugs Dermatol. 2018;17(10):1051-1057.
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Kosar L, Laubscher T. Management of impetigo and cellulitis: Simple considerations for promoting appropriate antibiotic use in skin infections. Can Fam Physician 2017; 63:615-618. [PMID: 28807958 PMCID: PMC5555330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Lynette Kosar
- Information Specialist for the RxFiles Academic Detailing Program for the Saskatoon Health Region in Saskatchewan and Assistant Clinical Professor in the College of Pharmacy at the University of Saskatchewan in Saskatoon.
| | - Tessa Laubscher
- Clinical Associate Professor of Academic Family Medicine at the University of Saskatchewan
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Yeoh DK, Anderson A, Cleland G, Bowen AC. Are scabies and impetigo "normalised"? A cross-sectional comparative study of hospitalised children in northern Australia assessing clinical recognition and treatment of skin infections. PLoS Negl Trop Dis 2017; 11:e0005726. [PMID: 28671945 PMCID: PMC5510902 DOI: 10.1371/journal.pntd.0005726] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 07/14/2017] [Accepted: 06/19/2017] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Complications of scabies and impetigo such as glomerulonephritis and invasive bacterial infection in Australian Aboriginal children remain significant problems and the overall global burden of disease attributable to these skin infections remains high despite the availability of effective treatment. We hypothesised that one factor contributing to this high burden is that skin infection is under-recognised and hence under-treated, in settings where prevalence is high. METHODS We conducted a prospective, cross-sectional study to assess the burden of scabies, impetigo, tinea and pediculosis in children admitted to two regional Australian hospitals from October 2015 to January 2016. A retrospective chart review of patients admitted in November 2014 (mid-point of the prospective data collection in the preceding year) was performed. Prevalence of documented skin infection was compared in the prospective and retrospective population to assess clinician recognition and treatment of skin infections. RESULTS 158 patients with median age 3.6 years, 74% Aboriginal, were prospectively recruited. 77 patient records were retrospectively reviewed. Scabies (8.2% vs 0.0%, OR N/A, p = 0.006) and impetigo (49.4% vs 19.5%, OR 4.0 (95% confidence interval [CI 2.1-7.7) were more prevalent in the prospective analysis. Skin examination was only documented in 45.5% of cases in the retrospective review. Patients in the prospective analysis were more likely to be prescribed specific treatment for skin infection compared with those in the retrospective review (31.6% vs 5.2%, OR 8.5 (95% CI 2.9-24.4). CONCLUSIONS Scabies and impetigo infections are under-recognised and hence under-treated by clinicians. Improving the recognition and treatment of skin infections by clinicians is a priority to reduce the high burden of skin infection and subsequent sequelae in paediatric populations where scabies and impetigo are endemic.
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Affiliation(s)
- Daniel K. Yeoh
- Department of Infectious Diseases, Princess Margaret Hospital for Children, Perth, Western Australia
- Division of Paediatrics, School of Medicine, University of Western Australia, Perth, Western Australia
- Paediatric Services, Western Australia Country Health Service Kimberley Region, Broome, Western Australia
- * E-mail:
| | - Aleisha Anderson
- Department of Infectious Diseases, Princess Margaret Hospital for Children, Perth, Western Australia
- Paediatric Services, Western Australia Country Health Service Kimberley Region, Broome, Western Australia
- Paediatric Services, Hedland Health Campus, Port Hedland, Western Australia
| | - Gavin Cleland
- Division of Paediatrics, School of Medicine, University of Western Australia, Perth, Western Australia
- Paediatric Services, Western Australia Country Health Service Kimberley Region, Broome, Western Australia
| | - Asha C. Bowen
- Department of Infectious Diseases, Princess Margaret Hospital for Children, Perth, Western Australia
- Division of Paediatrics, School of Medicine, University of Western Australia, Perth, Western Australia
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory
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Qin R, Cohen PR. Concurrent pyogenic granuloma and bullous impetigo of a pregnant woman's finger. Dermatol Online J 2017; 23:13030/qt0p22m4dg. [PMID: 28329529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 03/22/2017] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Bullous impetigo is a superficial skininfection caused by Staphylococcus aureus (S.aureus). Pyogenic granuloma is a common benigntumor frequently associated with prior trauma.Bullous impetigo and pyogenic granuloma may occurin pregnant women. PURPOSE The features of a pregnant womanwith pyogenic granuloma and bullous impetigoconcurrently present in a lesion on her finger aredescribed. METHODS PubMed was used to search the followingterms: bullous impetigo, pregnancy, and pyogenicgranuloma. All papers were reviewed; relevantarticles, along with their references, were evaluatedResults: A red ulcerated nodule with a collaretteof epithelium around the tumor and surroundingbullae appeared on the fifth digit of the left hand of a31-year-old woman who was at 36 weeks gestation. Abacterial culture grew methicillin sensitive S. aureus.An excisional biopsy was performed. Histologicfindings revealed not only a benign vascular tumorwith an infiltrate of mixed inflammatory cells, butalso an intraepidermal blister. She received oralantibiotics and there was complete resolution of thefinger lesion and infection with preservation of digitfunction. CONCLUSION Albeit uncommon, pyogenic granulomaand bullous impetigo may concurrently occur in thesame lesion. Therapeutic intervention should focuson treating both the benign skin tumor and theinfection.
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Affiliation(s)
- Rosie Qin
- Department of Medicine, University of California San Diego, La Jolla, California.
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Abstract
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.
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Affiliation(s)
- Kathy VanRavenstein
- Kathy VanRavenstein is an instructor at the Medical University of South Carolina, College of Nursing, Charleston, S.C. Whitney Smith is an instructor at the Medical University of South Carolina, College of Nursing, Charleston, S.C. Catherine O'Connor Durham is an assistant professor at the Medical University of South Carolina, College of Nursing, Charleston, S.C. Tiffany H. Williams is an assistant professor at the Medical University of South Carolina, College of Nursing, Charleston, S.C
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Rakshit T, Shenoy M S. How resistant is Staphylococcus aureus to the topical antibiotic mupirocin? J Glob Antimicrob Resist 2017; 8:102-103. [PMID: 28082145 DOI: 10.1016/j.jgar.2016.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 12/09/2016] [Accepted: 12/18/2016] [Indexed: 11/17/2022] Open
Affiliation(s)
- Tanya Rakshit
- Department of Microbiology, Kasturba Medical College, Manipal University, Mangalore, Karnataka 575001, India
| | - Suchitra Shenoy M
- Department of Microbiology, Kasturba Medical College, Manipal University, Mangalore, Karnataka 575001, India.
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Gupta AK, Versteeg SG, Abramovits W. Ozenoxacin Cream, 1% - Topical Treatment of Impetigo. Skinmed 2017; 15:57-59. [PMID: 28270312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Aditya K Gupta
- Department of Medicine, University of Toronto School of Medicine, Toronto, Ontario, Canada, Dallas, TX;
- Mediprobe Research Inc., London, Ontario, Canada, Dallas, TX
| | | | - William Abramovits
- Department of Medicine, Baylor University Medical Center, Dallas, TX
- Departments of Dermatology and Family Practice, University of Texas Southwestern Medical School, Dallas, TX
- Dermatology Treatment and Research Center, Dallas, TX
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Vogel A, Lennon D, Best E, Leversha A. Where to from here? The treatment of impetigo in children as resistance to fusidic acid emerges. N Z Med J 2016; 129:77-83. [PMID: 27736855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Admissions for skin and soft-tissue infections have been increasing steadily in children and in the general population. Concerns have been raised recently about the increasing widespread use of topical fusidic acid and concurrent increase of fusidic acid-resistant Staphylococcus aureus. Fusidic acid resistance and methicillin resistant Staphylococcus aureus (MRSA) are both more prevalent in youngest age group (<5 year-olds) and particularly in the North island. In New Zealand, fusidic acid is recommended for treatment of minor impetigo and is the only fully-funded topical antibiotic. The evidence base for alternative treatment strategies for mild impetigo is limited. Most children with impetigo in the current Counties Manukau skin and sore throat schools programme received care with wound management with only a few requiring escalation. An upcoming randomised controlled trial comparing topical hydrogen peroxide cream, topical fusidic acid and wound management only (clean and cover) will help provide evidence about the effectiveness of alternative treatments in the New Zealand setting.
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Affiliation(s)
- Alison Vogel
- Paediatrician, Department of Paediatrics, University of Auckland, KidzFirst Children's Hospital, Auckland
| | - Diana Lennon
- Professor of Population Child and Youth Health, Department of Paediatrics, University of Auckland, Starship Children's Health, Auckland
| | - Emma Best
- Paediatrician, Senior Lecturer, Department of Paediatrics, University of Auckland, Starship Children's Health, Auckland
| | - Alison Leversha
- Community Paediatrician, Starship Children's Health, Auckland
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Chamny S, Miron D, Lumelsky N, Shalev H, Gazal E, Keynan R, Shemer A, Tamarkin D. Topical Minocycline Foam for the Treatment of Impetigo in Children: Results of a Randomized, Double-Blind, Phase 2 Study. J Drugs Dermatol 2016; 15:1238-1243. [PMID: 27741342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Currently available treatment options for impetigo are limited by either systemic side effects (for oral therapy) or lack of ease of use (for topical ointment). A novel foam formulation of minocycline for topical use may improve convenience and treatment utilization for pediatric patients with impetigo. OBJECTIVE To evaluate the safety and efficacy of topically applied minocycline foam (FMX-102 1% and 4%) in the treatment of impetigo and to determine the optimal therapeutic active ingredient concentration. METHODS In this randomized, parallel-group, double-blind, comparative clinical trial, 32 subjects aged ≥2 years with a clinical diagnosis of pure impetigo, impetigo contagiosa, or uncomplicated blistering impetigo were randomized to treatment with FMX-102 1% or 4%, twice daily for 7 days. Subjects were followed for up to 7 days post-treatment. RESULTS Clinical cure, defined as ≥80% cured lesions (fully recovered lesions, visually determined by investigators), was achieved by 57.1% and 50.0% of FMX-102 1% and 4% subjects, respectively, at the end of treatment (visit 3). Clinical success, defined as the absence of lesions, or the drying or improvement of treated lesions (decrease in size of affected area, lesion number, or both), was demonstrated in 81.3% and 78.6% of FMX-102 1% and 4% subjects, respectively, following 3 days of treatment (visit 2), in 92.3% and 100% of the respective subjects at the end of treatment, and in 100% in both groups at follow-up (visit 4). Bacteriologic success rates at the end of treatment, defined as complete pathogen eradication, were 85% and 74% in the FMX-102 1% and 4% groups, respectively. The bacteriologic success rate for MRSA infections was 100% (11/11), with no recurrences. Both FMX-102 1% and 4% were considered well tolerated and safe. CONCLUSION Topical minocycline foam may be a safe and effective new treatment option for impetigo in children, including those with MRSA. <br /><br /> <em>J Drugs Dermatol.</em> 2016;15(10):1238-1243.
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Affiliation(s)
- Shricharith Shetty
- Department of Dermatology, Kasturba Medical College, Manipal, Manipal University, Manipal, India
| | - Raghavendra Rao
- Department of Dermatology, Kasturba Medical College, Manipal, Manipal University, Manipal, India
| | - Sathish Pai
- Department of Dermatology, Kasturba Medical College, Manipal, Manipal University, Manipal, India
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Romani L, Whitfeld MJ, Koroivueta J, Kama M, Wand H, Tikoduadua L, Tuicakau M, Koroi A, Andrews R, Kaldor JM, Steer AC. Mass Drug Administration for Scabies Control in a Population with Endemic Disease. N Engl J Med 2015; 373:2305-13. [PMID: 26650152 DOI: 10.1056/nejmoa1500987] [Citation(s) in RCA: 167] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Scabies is an underrecognized cause of illness in many developing countries. It is associated with impetigo, which can lead to serious systemic complications. We conducted a trial of mass drug administration for scabies control in Fiji. METHODS We randomly assigned three island communities to one of three different interventions for scabies control: standard care involving the administration of permethrin to affected persons and their contacts (standard-care group), mass administration of permethrin (permethrin group), or mass administration of ivermectin (ivermectin group). The primary outcome was the change in the prevalence of scabies and of impetigo from baseline to 12 months. RESULTS A total of 2051 participants were enrolled; 803 were in the standard-care group, 532 in the permethrin group, and 716 in the ivermectin group. From baseline to 12 months, the prevalence of scabies declined significantly in all groups, with the greatest reduction seen in the ivermectin group. The prevalence declined from 36.6% to 18.8% in the standard-care group (relative reduction in prevalence, 49%; 95% confidence interval [CI], 37 to 60), from 41.7% to 15.8% in the permethrin group (relative reduction, 62%; 95% CI, 49 to 75), and from 32.1% to 1.9% in the ivermectin group (relative reduction, 94%; 95% CI, 83 to 100). The prevalence of impetigo also declined in all groups, with the greatest reduction seen in the ivermectin group. The prevalence declined from 21.4% to 14.6% in the standard-care group (relative reduction, 32%; 95% CI, 14 to 50), from 24.6% to 11.4% in the permethrin group (relative reduction, 54%; 95% CI, 35 to 73), and from 24.6% to 8.0% in the ivermectin group (relative reduction, 67%; 95% CI, 52 to 83). Adverse events were mild and were reported more frequently in the ivermectin group than in the permethrin group (15.6% vs. 6.8%). CONCLUSIONS Mass drug administration, particularly the administration of ivermectin, was efficacious for the control of scabies and impetigo. (Funded by the Australian National Health and Medical Research Council; Australian New Zealand Clinical Trials Registry number, ACTRN12613000474752.).
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Affiliation(s)
- Lucia Romani
- From Kirby Institute, University of New South Wales (L.R., H.W., J.M.K.), and the Department of Dermatology, St. Vincent's Hospital (M.J.W.), Sydney, Menzies School of Health Research, Charles Darwin University, Darwin, NT (R.A.), and the Centre for International Child Health, University of Melbourne (A.C.S.), Group A Streptococcal Research Group, Murdoch Children's Research Institute (A.C.S.), and Department of General Medicine, Royal Children's Hospital (A.C.S.), Melbourne, VIC - all in Australia; and the Ministry of Women, Children, and Poverty Alleviation (J.K.) and the Ministry of Health (M.K., L.T., M.T., A.K.) - both in Suva, Fiji
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Salah LA, Faergemann J. A retrospective analysis of skin bacterial colonisation, susceptibility and resistance in atopic dermatitis and impetigo patients. Acta Derm Venereol 2015; 95:532-5. [PMID: 25367860 DOI: 10.2340/00015555-1996] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Atopic dermatitis (AD) and impetigo are skin conditions where bacterial colonisation and infection, especially with Staphylococcus aureus play an important role. We compared skin bacterial population, resistance patterns and choice of antimicrobial agents in patients diagnosed with AD and impetigo during 2005 and 2011 in our department. Number of positive cultures in the AD group were 40 and 53 in 2005 and 2011, with S. aureus found in 97.5% and 100%, respectively. Differences in resistance were marginal. In impetigo, S. aureus was found in all 70 patients in 2005 and all 40 patients in 2011. Antibiotic resistance to specifically fusidic acid was more common in 2005 impetigo patients (22.8%) versus 2011 (5%) (p = 0.078). The most commonly used oral antimicrobial was cefadroxil (in 57.5% and 52.8% of AD and 58.6% and 35% of impetigo patients in 2005 and 2011, respectively). Our observations confirm the high prevalence of S. aureus in both diseases and, interestingly, show a declining resistance trend in impetigo.
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Affiliation(s)
- Louai A Salah
- Department of Dermatology and Venereology, Sahlgrenska University Hospital, SE 413 45 Gothenburg, Sweden.
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Bowen AC, Tong SYC, Andrews RM, O'Meara IM, McDonald MI, Chatfield MD, Currie BJ, Carapetis JR. Short-course oral co-trimoxazole versus intramuscular benzathine benzylpenicillin for impetigo in a highly endemic region: an open-label, randomised, controlled, non-inferiority trial. Lancet 2014; 384:2132-40. [PMID: 25172376 DOI: 10.1016/s0140-6736(14)60841-2] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Impetigo affects more than 110 million children worldwide at any one time. The major burden of disease is in developing and tropical settings where topical antibiotics are impractical and lead to rapid emergence of antimicrobial resistance. Few trials of systemic antibiotics are available to guide management of extensive impetigo. As such, we aimed to compare short-course oral co-trimoxazole with standard treatment with intramuscular benzathine benzylpenicillin in children with impetigo in a highly endemic setting. METHODS In this randomised, controlled, non-inferiority trial, Indigenous Australian children aged 3 months to 13 years with purulent or crusted non-bullous impetigo were randomly assigned (1:1:1) to receive benzathine benzylpenicillin (weight-banded injection), twice-daily co-trimoxazole for 3 days (4 mg/kg plus 20 mg/kg per dose), or once-daily co-trimoxazole for 5 days (8 mg/kg plus 40 mg/kg per dose). At every visit, participants were randomised in blocks of six and 12, stratified by disease severity. Randomisation was done by research nurses and codes were in sealed, sequentially numbered, opaque envelopes. Independent reviewers masked to treatment allocation compared digital images of sores from days 0 and 7. The primary outcome was treatment success at day 7 in a modified intention-to-treat analysis. This trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12609000858291. FINDINGS Between Nov 26, 2009, and Nov 20, 2012, 508 patients were randomly assigned to receive benzathine benzylpenicillin (n=165 [156 analysed]), twice-daily co-trimoxazole for 3 days (n=175 [173 analysed]), or once-daily co-trimoxazole for 5 days (n=168 [161 analysed]). Treatment was successful in 133 (85%) children who received benzathine benzylpenicillin and 283 (85%) who received pooled co-trimoxazole (absolute difference 0·5%; 95% CI -6·2 to 7·3), showing non-inferiority of co-trimoxazole (10% margin). Results for twice-daily co-trimoxazole for 3 days and once-daily co-trimoxazole for 5 days were similar. Adverse events occurred in 54 participants, 49 (90%) of whom received benzathine benzylpenicillin. INTERPRETATION Short-course co-trimoxazole is a non-inferior, alternative treatment to benzathine benzylpenicillin for impetigo; it is palatable, pain-free, practical, and easily administered. FUNDING Australian National Health and Medical Research Council.
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Affiliation(s)
- Asha C Bowen
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
| | - Steven Y C Tong
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Ross M Andrews
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Irene M O'Meara
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | | | - Mark D Chatfield
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Bart J Currie
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
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van der Wouden JC, Koning S. Treatment of impetigo in resource-limited settings. Lancet 2014; 384:2090-1. [PMID: 25172375 DOI: 10.1016/s0140-6736(14)61395-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Johannes C van der Wouden
- Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, 1007 MB, Amsterdam, Netherlands.
| | - Sander Koning
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Netherlands
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Hartman-Adams H, Banvard C, Juckett G. Impetigo: diagnosis and treatment. Am Fam Physician 2014; 90:229-235. [PMID: 25250996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Impetigo is the most common bacterial skin infection in children two to five years of age. There are two principal types: nonbullous (70% of cases) and bullous (30% of cases). Nonbullous impetigo, or impetigo contagiosa, is caused by Staphylococcus aureus or Streptococcus pyogenes, and is characterized by honey-colored crusts on the face and extremities. Impetigo primarily affects the skin or secondarily infects insect bites, eczema, or herpetic lesions. Bullous impetigo, which is caused exclusively by S. aureus, results in large, flaccid bullae and is more likely to affect intertriginous areas. Both types usually resolve within two to three weeks without scarring, and complications are rare, with the most serious being poststreptococcal glomerulonephritis. Treatment includes topical antibiotics such as mupirocin, retapamulin, and fusidic acid. Oral antibiotic therapy can be used for impetigo with large bullae or when topical therapy is impractical. Amoxicillin/clavulanate, dicloxacillin, cephalexin, clindamycin, doxycycline, minocycline, trimethoprim/sulfamethoxazole, and macrolides are options, but penicillin is not. Natural therapies such as tea tree oil; olive, garlic, and coconut oils; and Manuka honey have been anecdotally successful, but lack sufficient evidence to recommend or dismiss them as treatment options. Treatments under development include minocycline foam and Ozenoxacin, a topical quinolone. Topical disinfectants are inferior to antibiotics and should not be used. Empiric treatment considerations have changed with the increasing prevalence of antibiotic-resistant bacteria, with methicillin-resistant S. aureus, macrolide-resistant streptococcus, and mupirocin-resistant streptococcus all documented. Fusidic acid, mupirocin, and retapamulin cover methicillin-susceptible S. aureus and streptococcal infections. Clindamycin proves helpful in suspected methicillin-resistant S. aureus infections. Trimethoprim/sulfamethoxazole covers methicillin-resistant S. aureus infection, but is inadequate for streptococcal infection.
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Affiliation(s)
- Holly Hartman-Adams
- West Virginia University Robert C. Byrd Health Sciences Center, Morgantown, WV, USA
| | - Christine Banvard
- West Virginia University Robert C. Byrd Health Sciences Center, Morgantown, WV, USA
| | - Gregory Juckett
- West Virginia University Robert C. Byrd Health Sciences Center, Morgantown, WV, USA
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Impetigo. Am Fam Physician 2014; 90:Online. [PMID: 25251010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Abstract
Forty-nine children aged 0.2-13 years with bullous and eroded lesions, from which Staphylococcus aureus was isolated, were diagnosed with impetigo and entered into a randomized, open-labeled trial of topical oxytetracycline hydrochloride (tetracycline) compared with a combination of topical tetracycline and oral antibiotics. After one week of topical tetracycline treatment, 22 of the 28 patients were clinically cured, and the remaining six patients had improved. In the other treatment group, 14 patients of 21 were clinically cured and 7 patients improved by the combination of topical tetracycline and oral antibiotics. There were no significant differences between the two groups. Therefore, the present study suggests that topical tetracycline treatment is effective for the treatment of impetigo.
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Affiliation(s)
- Shuichi Kuniyuki
- Department of Dermatology, Osaka City General Hospital, Osaka, Japan
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Shim J, Lanier J, Qui MK. Clinical inquiry: what is the best treatment for impetigo ? J Fam Pract 2014; 63:333-335. [PMID: 25061625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Jae Shim
- Martin Army Community Hospital, Fort Benning, GA, USA
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45
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Shallcross LJ, Petersen I, Rosenthal J, Johnson AM, Freemantle N, Hayward AC. Use of primary care data for detecting impetigo trends, United kingdom, 1995-2010. Emerg Infect Dis 2014; 19:1646-8. [PMID: 24047615 PMCID: PMC3810750 DOI: 10.3201/eid1910.130433] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Using a primary care database, we identified a major increase in impetigo in the United Kingdom during 1995–2010. Despite a doubled rate of primary care consultations, this increase was not identified by routine surveillance. Primary care databases are a valuable and underused source of surveillance data on infectious diseases.
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Sandra L. Impetigo: treatment and management. Nurs Times 2014; 110:18-20. [PMID: 24683751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Impetigo is the third most common skin disease in children. It is highly infectious and can be transmitted through direct and indirect contact. This article discusses the types of impetigo, its cause, diagnosis and management, and highlights additional guidance and resources that can support practice.
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Gray S, Lennon D, Anderson P, Stewart J, Farrell E. Nurse-led school-based clinics for skin infections and rheumatic fever prevention: results from a pilot study in South Auckland. N Z Med J 2013; 126:53-61. [PMID: 23797077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
AIM To assess the acceptability and feasibility of delivering targeted primary health care in a decile one primary school setting. METHOD A pilot public health nurse (PHN)-led clinic was set up in a South Auckland primary school (roll approximately 400). The clinic was based on a previous sore throat clinic model with modifications aimed at improving programme feasibility and effectiveness. The timely identification and treatment of Group A Streptococcal (GAS) throat infections to prevent rheumatic fever (RF), and the prevention and treatment of four skin infections (cellulitis, impetigo, infected eczema and scabies) were the focus. The pilot ran for 15 weeks from April to July 2011. Evaluation included documentation review, key school and healthcare stakeholder interviews and parent questionnaires. RESULTS The consent rate was 92.2%. Of a total 722 throat swabs taken from 337 students, 94 were GAS positive. Ninety-eight assessments of skin conditions were completed at which 76 had a skin infection diagnosed, the most common infection being impetigo (n=46). Thirty-one skin infections were diagnosed in the first week of the pilot. PHN workload was high with a total of 539 phone calls, 137 home visits and 51 school-based parent consultations. The approach was highly acceptable to the majority of key stakeholders. Extrapolating pilot costs results in an estimated annual cost of $510 per student for the programme. CONCLUSION It is likely to be both acceptable and feasible to take this model of delivering targeted primary health care to school aged children and use it on a larger scale. The complexity of providing this type of service should not be underestimated and it is essential that robust processes are in place to ensure smooth, safe running of such a programme. Long-term outcome evaluation will be vital to assess programme effectiveness.
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Affiliation(s)
- Sarah Gray
- Counties Manukau District Health Board, Auckland, New Zealand
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Vaidya DC, Kroumpouzos G, Bercovitch L. Recurrent postpartum impetigo herpetiformis presenting after a "skip" pregnancy. Acta Derm Venereol 2013; 93:102-3. [PMID: 22854922 DOI: 10.2340/00015555-1352] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Bolaji RS, Dabade TS, Gustafson CJ, Davis SA, Krowchuk DP, Feldman SR. Treatment of impetigo: oral antibiotics most commonly prescribed. J Drugs Dermatol 2012; 11:489-494. [PMID: 22453587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Impetigo is a highly contagious, superficial skin disease that is frequently seen in children. While data support the use of topical antibiotics for treatment, the medications actually prescribed in practice are not well documented. OBJECTIVES To determine the prescribing pattern of dermatologists and nondermatologists when treating impetigo and the demographics of the patients treated. METHODS National Ambulatory Medical Care Survey data on office visits for impetigo were analyzed from 1997 to 2007. Patient demographics and the treatments for impetigo were recorded. RESULTS During this 10-year period, dermatologists managed an estimated 274,815 impetigo visits and nondermatologists an estimated 3,722,462 visits. Both dermatologists and nondermatologists most frequently prescribed oral antibiotics to treat impetigo. Topical antibiotics were second most common, and a variety of combination treatments were used. CONCLUSIONS Oral antibiotics are the most common class of medications used to treat impetigo. There is an opportunity for physicians to take advantage of the equally efficacious topical antibiotics for treating impetigo. A shift towards topical antibiotics would likely decrease morbidity (resulting from adverse effects) associated with use of oral agents.
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Affiliation(s)
- Ranti S Bolaji
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1071, USA
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Abstract
BACKGROUND 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. OBJECTIVES To assess the effects of treatments for impetigo, including non-pharmacological interventions and 'waiting for natural resolution'. SEARCH METHODS 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. SELECTION CRITERIA Randomised controlled trials of treatments for non-bullous, bullous, primary, and secondary impetigo. DATA COLLECTION AND ANALYSIS Two independent authors undertook all steps in data collection. We performed quality assessments and data collection in two separate stages. MAIN RESULTS 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. AUTHORS' CONCLUSIONS 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.
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Affiliation(s)
- Sander Koning
- Erasmus Medical CenterDepartment of General PracticePO Box 2040Room Ff303RotterdamNetherlands3000 CA
| | - Renske van der Sande
- Erasmus Medical CenterDepartment of General PracticePO Box 2040Room Ff303RotterdamNetherlands3000 CA
| | - Arianne P Verhagen
- Erasmus Medical CenterDepartment of General PracticePO Box 2040Room Ff303RotterdamNetherlands3000 CA
| | - Lisette WA van Suijlekom‐Smit
- Erasmus MC ‐ Sophia Children's HospitalDepartment of Paediatrics, Paediatric RheumatologyPO Box 2060RotterdamNetherlands3000 CB
| | - Andrew D Morris
- University of Wales College of MedicineDepartment of DermatologyCardiffWalesUK
| | - Christopher C Butler
- University of OxfordNuffield Department of Primary Care Health SciencesWoodstock RoadOxfordUKOX2 6GG
| | - Marjolein Berger
- Erasmus Medical CenterDepartment of General PracticePO Box 2040Room Ff303RotterdamNetherlands3000 CA
- University Medical Centre GroningenDepartment of General PracticeGroningenNetherlands
| | - Johannes C van der Wouden
- Erasmus Medical CenterDepartment of General PracticePO Box 2040Room Ff303RotterdamNetherlands3000 CA
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