title: Topical 2% mupirocin versus 2% fusidic acid ointment in the treatment of primary and secondary skin infections. Double-blind study comparing erythromycin and mupirocin for treatment of impetigo in children: implications of a high prevalence of erythromycin-resistant Staphylococcus aureus strains. Skin and plasma levels of acetylsalicylic acid: a comparison between topical aspirin/diethyl ether mixture and oral aspirin in acute herpes zoster and postherpetic neuralgia A comparison of sodium fusidate ointment and mupirocin ointment in superficial skin sepsis. Topical antibiotics in the treatment of superficial skin infections in general practice--a comparison of mupirocin with sodium fusidate. The antibacterial activity of tea in vitro and in vivo (in patients with impetigo contagiosa). Topical antibiotic treatment of impetigo with mupirocin. Topical antibiotics in pyodermas Treatment of impetigo and ecthyma. A comparison of sulconazole with miconazole. Impetigo. Current etiology and comparison of penicillin, erythromycin, and cephalexin therapies. Comparison of mupirocin and erythromycin in the treatment of impetigo.
abstract: The efficacy and side effects of topical mupirocin ( Bactroban ) and fusidic acid ( Fucidin ) ointment were compared in a double-blind , r and omized trial in 70 patients who came to the Dermatologic Clinic of L'Enfant Jésus Hospital with primary or secondary ( or both ) skin infections . Thirty-five patients were treated with mupirocin  and 35 patients were treated with fusidic acid three times a day for seven days . Clinical and bacteriologic assessment s were conducted before and after treatment . The efficacy of mupirocin , in terms of resolution and improvement of clinical signs and symptoms of infection , as well as of the elimination of infecting organisms , was similar to that of fusidic acid . Of 34 patients ( 1 could not be evaluated ) treated with mupirocin , a clinical cure was achieved in 18 , and significant improvement was demonstrated in 15 . Similarly , of 35 patients treated with fusidic acid , a clinical cure was achieved in 18 and improvement occurred in 15 . Bacteriologic cure rates were 97 % ( 30 of 31 patients evaluated ) in the mupirocin-treated group , compared with 87 % ( 27 of 31 patients evaluated ) in the fusidic acid-treated group . No side effects were observed in either treatment group . Because topical 2 % mupirocin has little or no potential for irritation , systemic side effects , or cross-resistance with other antibiotics , its efficacy is likely to make this new compound a useful agent for the treatment of superficial skin infections Staphylococcus aureus has been consistently isolated from a high proportion of impetiginous lesions , and in several recent studies , it was present in the majority of the cases . Since recently a large proportion of S. aureus strains in our community showed erythromycin resistance , we undertook a prospect i ve double-blind controlled study comparing topical mupirocin with oral erythromycin to determine ( i ) the prevalence of erythromycin-resistant S. aureus strains in impetigo and ( ii ) whether an increased rate of failure of erythromycin treatment was associated with such resistance . A total of 102 patients 3 to 185 months old ( median = 49 months ) were enrolled .  Culture was positive for 97 of 102 ( 95 % ) patients , and S. aureus was present in 93 % of the patients for whom cultures were positive . S. aureus was the single pathogen in 64 % of these patients . Erythromycin-resistant S. aureus strains were present in 27 of 91 ( 28 % ) patients for whom cultures were positive . In all cases but one , S. aureus was resistant to penicillin , and in all cases it was sensitive to mupirocin . A marked difference was observed in favor of mupirocin in the clinical courses of the disease . However , only patients with erythromycin-resistant S. aureus strains had unfavorable courses compared with those treated with mupirocin ( failure rate , 47 versus 2 % , respectively ) . Patients with erythromycin-susceptible S. aureus strains who received erythromycin had a failure rate of 8 % . In four patients , S. aureus strains initially susceptible to erythromycin became resistant during treatment . We conclude that erythromycin-resistant S. aureus strains are commonly isolated from impetigo in our region . ( ABSTRACT TRUNCATED AT 250 WORDS Abstract Objective : The aim of this investigation was to eluci date whether the analgesic effect was due to the local aspirin or to the systemic drug . This was done by comparing skin and plasma levels of acetylsalicylic acid ( ASA ) and salicylic acid ( SA ) after topically administered ASA/diethyl ether ( ADE ) mixture in acute herpetic neuralgia ( AHN ) and postherpetic neuralgia ( PHN ) . The analgesia and the plasma and skin levels of ASA were also determined after oral administration of aspirin . Methods : Nineteen patients , 11 ( 57.9 % ) with AHN and ␣ 8 ( 42.1 % ) with PHN were given , on different days , a single 500-mg oral dose of ASA or a topical dose ( 750 mg ) of ( ADE ) daubed onto the painful skin . The analgesic effect was assessed by means of a visual analogue scale ( VAS ) . Overall pain relief was grade d as : excellent , good , fair , or poor . AHN as well as PHN patients had severe pain at baseline ( 6.83 and 5.93 ) . Levels of ASA and SA in plasma and in the stratum corneum after adhesive tape stripping of the treated area were determined by HPLC . Results : After ADE application , the analgesic effect was very rapid and VAS scores were lower than at baseline . Pain significantly decreased by 82.6 % after topical and 15.4 % after oral ASA . After ADE , 95 % of the patients had excellent or good pain relief , but after oral administration 79 % of the patients had a poor response . Pain relief was similar in the two subgroups after ADE . Skin concentrations of ASA , but not of SA , after ADE were about 80- to 100-fold those after oral administration . Levels of ASA and SA in plasma after oral administration were similar to those previously found , but after ADE were undetectable or very low . Patients with excellent pain relief showed a trend towards higher ASA skin concentrations . Conclusions : The analgesic effect can be obtained only after topical administration , because by this route the skin levels of ASA are much higher than after oral administration . The mechanism is exclusively local ; there are no active drugs in plasma after topical administration Sodium fusi date ointment and mupirocin ointment were compared in 354 patients with superficial skin sepsis . The ointments were applied 3-times daily , or once daily when covered by a dressing , and the response assessed after 6 to 8 days . Both preparations proved effective clinical ly with 86 % of patients responding . There was no difference between the two preparations in cases of primary infection ( 85 % to both ointments ) , including a sub-group with impetigo ( sodium fusi date 88 % and mupirocin 84 % ) , or secondary infection ( sodium fusi date 81 % and mupirocin 89 % ) . Sodium fusi date ointment ( 98 % ) was significantly better ( p less than 0.05 ) than mupirocin ( 82 % ) in patients with other superficial infections . Both ointments were equally effective in cases where Gram-positive , Gram-negative or mixed Gram-positive/Gram-negative bacteria were isolated . Adverse effects were reported in 1.0 % of patients using sodium fusi date ointment and in 7.4 % of patients using mupirocin ointment . The majority of complaints concerned the greasiness of mupirocin ointment A total of 413 eligible patients took part in an observer-blind r and omised multicentre clinical trial in order to compare the clinical and bacteriological efficacy of mupirocin ( Bactroban ) ointment with sodium fusi date ( Fucidin ) ointment for treating  superficial skin infections seen in general practice .  Mupirocin was applied twice daily and sodium fusi date thrice daily for a period of 7 days . Both treatments were similarly effective with 97 % patients treated with mupirocin and 93 % patients treated with sodium fusi date responding . Mupirocin was significantly more effective in the treatment of acute primary skin infections and in the treatment of a subgroup of patients with impetigo ( P less than 0.01 ) . Of the organisms detected before treatment began , 93 % were not found after treatment with mupirocin compared with 89 % after treatment with sodium fusi date .  Staphylococcus aureus and /or beta-haemolytic streptococci appeared to be eliminated in significantly more patients treated with mupirocin ( 96 % ) compared with those treated with sodium fusi date ( 88 % ) , ( P = 0.03 ) . Both treatments were well tolerated A total number of 104 patients with impetigo contagiosa was included in this study . They were 47 females ( 45.2 % ) and 57 males ( 54.8 % ) . Their ages ranged from one month to 40 years with a median of 4 years . This study was divided into two parts : PART I ( in vitro ) : Thirty-five patients were swabbed to determine the microbiology of impetigo contagiosa which included 33 isolates of pure S. aureus ( 94.3 % ) and 2 of a combination of S. aureus and Streptococcus pyogenes ( 5.7 % ) . The antibacterial effect of tea liquor ( lotion ) against S. aureus proved very effective . Antibiotic sensitivity was done for all bacterial isolates of S. aureus . PART II ( in vivo ) : The antibacterial effects of tea liquor and ointment were tested by treating 64 patients with impetigo contagiosa . Tea ointment was very effective with a cure rate of 81.3 % . Forty patients were taken as controls and divided into two groups . The first one was given an ointment containing Framycetin and gramicidin ( soframycin ) with a cure rate of 72.2 % ; the other group was given oral cephalexin with a cure rate of 78.6 % . To the best of our knowledge , this study was the first one which demonstrated the anti-bacterial action of crude tea in vivo , against impetigo contagiosa . Clinical data about impetigo are also included in this study Because the effectiveness of topical antimicrobials in the treatment of ecthyma , impetigo , and pyoderma is not well established , the US Food and Drug Administration has recently proposed guidelines for tests of topical antimicrobial efficacy in primary skin infections . The guidelines require both comparison with the agent 's base and microbiologic documentation of efficacy . These guidelines were followed in this double-blind , eight-day evaluation of impetigo/ecthyma treated with mupirocin , a new agent that is only active topically . All cultures , before and after therapy , were taken using swabs dipped in neutralizing broth plus 10 % fetal bovine serum to minimize antimicrobial " carry over " to the culture plate . Staphylococcus aureus , which was isolated from 94 % of the patients before therapy , was eliminated in 88 % of the mupirocin-treated patients and 47 % of the vehicle-treated patients . Group A beta-hemolytic streptococci were eliminated in 100 % of the mupirocin-treated and 0 % of the vehicle-treated patients . To our knowledge , this is the first topical antibacterial treatment for  primary skin infections proved superior to its vehicle using the proposed US Food and Drug Administration guidelines The value of topical antibiotics in the treatment of pyodermas was reassessed . In a double‐blind study , the efficacy of 0.1 % gentamicin cream was tested . There was no significant statistical difference in the degree of improvement between the group of patients that received the gentamicin cream and those treated with a placebo . The response obtained was thought to be due to washing and removal of crusts . Hence , it is considered advisable to abstain from the use of topical antibiotics in pyodermas In a r and omized , double-blind , parallel comparative study of 80 patients , impetigo and ecthyma were treated effectively by sulconazole nitrate 1 % cream and miconazole nitrate 2 % cream applied to lesions twice daily for 14 days . When treatment began , bacterial cultures from all pyodermal lesions yielded Group A beta-hemolytic streptococci or pathogenic staphylococci . Among the 32 sulconazole-treated impetigo patients , bacterial cultures from 26 ( 69 % ) were negative by treatment day 4 , and those from all 32 ( 100 % ) were negative by treatment day 7 ; among the 34 miconazole-treated impetigo patients , cultures from 17 ( 50 % ) were negative by treatment day 4 , cultures from 32 ( 94.1 % ) were negative by treatment day 7 , and cultures from 29 ( 97 % ) were negative by treatment day 14 . Each treatment promptly relieved the pyodermal signs ( crusts , vesicles , pustules , bullae , and exu date ) . Both agents were considered to be safe and effective medications for treating impetigo and ecthyma We attempted to determine the causative bacterial pathogens of impetigo in children in our area , to compare the effectiveness of three frequently used oral antimicrobial treatment regimens , and to correlate the antimicrobial sensitivity of the bacterial isolates with clinical responses to treatment . Seventy-three children with impetigo were r and omly assigned to receive penicillin V potassium or cephalexin monohydrate , both administered in dosages of 40 to 50 mg/kg per day , or erythromycin estolate administered in a dosage of 30 to 40 mg/kg per day . All drugs were given in three divided doses for 10 days . Treatment failure was defined as persistence of lesions 8 to 10 days after initiation of drug therapy as determined by examiners blinded to the treatment therapies . Forty-five ( 62 % ) cultures showed Staphylococcus aureus only , 14 ( 19 % ) showed S aureus and group A beta-hemolytic streptococci , six ( 8 % ) showed group A beta-hemolytic streptococci only , and eight ( 11 % ) showed no growth or other organisms . Treatment failure occurred in six ( 24 % ) of 25 patients treated with penicillin V , one ( 4 % ) of 25 patients treated with erythromycin estolate , and no patients treated with cephalexin . We conclude that S aureus is the most common cause of impetigo in children in our study population , that cephalexin is the most effective treatment , that erythromycin estolate is nearly equally effective and may be preferred on a cost-effectiveness basis , and that penicillin V is inadequate for treatment of this infection For the past two decades the accepted treatment of impetigo has been systemic antibiotic therapy , l The recently approved topical antibiotic mupirocin has excellent in vitro activity against Streptococcus pyogenes and Staphylococcus aureus , including multiply resistant strains . Originally called pseudomonic acid A , mupirocin is obtained from submerged fermentation of Pseudomonas fluorescens ; it acts by inhibition of bacterial protein synthesis by inactivation of isoleucyl transfer RNA synthetase . Rapidly inactivated and rapidly excreted when given systemically , mupirocin has been shown to be safe in animal and human trials.2 , 3 Double-blind studies prove mupirocin to be more effective than its polyethylene glycol vehicle for treatment of impetigo.4 , 5 Several nonblind or poorly controlled clinical trials have suggested that mupirocin  's  efficacy is comparable to that of orally administered antibiotics commonly used to treat impetigo , namely , erythromycin , 6 - 1~ ampicillin , 11 and dicloxacillin . 12 We intended to vali date these findings in a double-blind , placebo-controlled study . We further hypothesized that erythromycin would cause more adverse side effects and result in poorer compliance , making mupirocin the preferred medication
target: This review found limited high- quality evidence to inform the treatment of impetigo .
background: BACKGROUND Impetigo is a common clinical problem seen in general practice .
  Uncertainty exists as to the most effective treatment , or indeed if treatment is necessary .
  AIM To determine the most effective treatment for impetigo in a systemically well patient .