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Review
. 2012 Jan 18;1(1):CD003261.
doi: 10.1002/14651858.CD003261.pub3.

Interventions for impetigo

Sander Koning  1 , Renske van der Sande, Arianne P Verhagen, Lisette W A van Suijlekom-Smit, Andrew D Morris, Christopher C Butler, Marjolein Berger, Johannes C van der Wouden
Affiliations
Review

Interventions for impetigo

Sander Koning et al. Cochrane Database Syst Rev. .

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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Conflict of interest statement

Three authors of this review are authors of one included trial (Sander Koning, Lisette WA van Suijlekom‐Smit, Johannes C van der Wouden; Koning 2003).

Sander Koning and Johannes C van der Wouden were also involved in a second trial (Koning 2008), which was initiated by the manufacturer of the drug. As employees of Erasmus MC, Rotterdam, Johannes C van der Wouden and Sander Koning received research funding from GlaxoSmithKline for participating in a study comparing retapamulin to placebo in participants with impetigo. The funding was used to pay staff involved in field work. They were also involved in publishing the results. The study was included in the update of this review.

Figures

1
1
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
2
2
Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
1.1
1.1. Analysis
Comparison 1 Non‐bullous impetigo: topical (Top) antibiotic (Ab) vs placebo (P), Outcome 1 Cure/improvement.
2.1
2.1. Analysis
Comparison 2 Non‐bullous impetigo: topical (Top) antibiotic (Ab) vs another topical (Top) antibiotic (Ab), Outcome 1 Cure/improvement.
3.1
3.1. Analysis
Comparison 3 Non‐bullous impetigo: topical (Top) antibiotic (Ab) vs oral (Or) antibiotic (Ab), Outcome 1 Cure/improvement.
3.2
3.2. Analysis
Comparison 3 Non‐bullous impetigo: topical (Top) antibiotic (Ab) vs oral (Or) antibiotic (Ab), Outcome 2 Cure/improvement.
4.1
4.1. Analysis
Comparison 4 Non‐bullous impetigo: topical (Top) antibiotic (Ab) vs disinfecting treatments (Dt), Outcome 1 Cure/improvement.
5.1
5.1. Analysis
Comparison 5 Non‐bullous impetigo: topical (Top) antibiotic (Ab) vs antifungal (Af), Outcome 1 Cure.
6.1
6.1. Analysis
Comparison 6 Non‐bullous impetigo: topical (Top) antibiotic (Ab) + oral (Or) antibiotic (Ab) vs topical (Top) antibiotic (Ab) + oral (Or) antibiotic (Ab), Outcome 1 Cure.
7.1
7.1. Analysis
Comparison 7 Non‐bullous impetigo: topical (Top) antibiotic (Ab) vs topical (Top) antibiotic (Ab) + oral (Or) antibiotic (Ab), Outcome 1 Cure.
8.1
8.1. Analysis
Comparison 8 Non‐bullous impetigo: oral (Or) antibiotics (Ab) vs placebo (P), Outcome 1 Cure/improvement.
9.1
9.1. Analysis
Comparison 9 Non‐bullous impetigo: oral (Or) antibiotic (Ab) (cephalosporin) vs another oral (Or) antibiotic (Ab), Outcome 1 Cure/improvement.
10.1
10.1. Analysis
Comparison 10 Non‐bullous impetigo: oral (Or) cephalosporin vs other oral (Or) cephalosporin, Outcome 1 Cure/improvement.
11.1
11.1. Analysis
Comparison 11 Non‐bullous impetigo: oral (Or) macrolide vs penicillin, Outcome 1 Cure/improvement.
12.1
12.1. Analysis
Comparison 12 Non‐bullous impetigo: oral (Or) macrolide vs another oral (Or) macrolide, Outcome 1 Cure/improvement.
13.1
13.1. Analysis
Comparison 13 Non‐bullous impetigo: oral (Or) penicillin vs other oral (Or) antibiotic (Ab) (including penicillin), Outcome 1 Cure/improvement.
14.1
14.1. Analysis
Comparison 14 Non‐bullous impetigo: other comparisons of oral (Or) antibiotics (Ab), Outcome 1 Cure/improvement.
15.1
15.1. Analysis
Comparison 15 Non‐bullous impetigo: oral (Or) antibiotics (Ab) vs disinfecting treatments (Dt), Outcome 1 Cure/improvement.
16.1
16.1. Analysis
Comparison 16 Bullous impetigo: topical (Top) antimicrobial vs placebo (P), Outcome 1 Cured/improved after 3 to 4 days.
17.1
17.1. Analysis
Comparison 17 Bullous impetigo: topical (Top) antibiotic (Ab) vs another topical (Top) antibiotic (Ab), Outcome 1 Cure/improvement.
18.1
18.1. Analysis
Comparison 18 Bullous impetigo: topical (Top) antibiotic (Ab) vs oral (Or) antibiotic (Ab), Outcome 1 Cure/improvement.
19.1
19.1. Analysis
Comparison 19 Bullous impetigo: oral (Or) antibiotic (Ab) vs another oral (Or) antibiotic (Ab), Outcome 1 Cure/improvement.
20.1
20.1. Analysis
Comparison 20 Secondary impetigo: topical (Top) antibiotic (Ab) vs oral (Or) antibiotic (Ab), Outcome 1 Cure/improvement.
21.1
21.1. Analysis
Comparison 21 Secondary impetigo: steroid (S) vs antibiotic (Ab), Outcome 1 Cure/improvement.
22.1
22.1. Analysis
Comparison 22 Secondary impetigo: steroid (S) + antibiotic (Ab) vs steroid (S), Outcome 1 Cure/improvement.
23.1
23.1. Analysis
Comparison 23 Secondary impetigo: steroid (S) + antibiotic (Ab) vs antibiotic (Ab), Outcome 1 Cure/improvement.
24.1
24.1. Analysis
Comparison 24 Secondary impetigo: oral (Or) antibiotic (Ab) vs another oral (Or) antibiotic (Ab), Outcome 1 Cure/improvement.
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References

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References to studies excluded from this review

Alavena 1987 {published data only}
    1. Alavena R, Roitman J, Cuadros C. Contagious impetigo [Impetigo contagioso. Evulacion de siete esquemas de tratamiento]. Revista de la Sanida de las Fuerzas Policialis 1987;48(1):20‐2.
Anonymous 1998 {published data only}
    1. Anonymous. Cefdinir ‐ A new oral Cephalosporin. The Medical Letter 1998;40(1034):85‐7. - PubMed
Arata 1983 {published data only}
    1. Arata J, Nohara N, Suwaki M, Umemura S, Nakagawa S, Miyoshi K, et al. Double‐blind comparison of cefadroxil and cephalexin granules in the treatment of impetigo. Japanese Journal of Antibiotics 1983;1443(36):1443‐60. - PubMed
Arata 1994 {published data only}
    1. Arata J, Kanzaki H, Abe Y, Torigoe R, Ohkawara A, Yamanaka K, et al. A multicenter, double‐blind, double‐placebo comparative study of SY 5555 versus cefaclor in the treatment of skin and skin structure infections. Chemotherapy 1994;42(6):740‐60.
Arosemena 1977 {published data only}
    1. Arosemena R, Bogaert H, Bonilla Dib E, Close de León J, Corrales H, Delgado Mayorga S, et al. Double blind study comparing preparations for topical application [Ensayo doble ciego entre preparaciones combinadas para aplicación tópica]. Investigación Médica Internacional 1977;4:502‐8.
Azimi 1999 {published data only}
    1. Azimi PH, Barson WJ, Janner D, Swanson R. Efficacy and safety of ampicillin/subactam and cefuroxime in the treatment of serious skin and skin structure infections in paediatric patients. Unasyn Pediatric Study Group. Pediatric Infectious Disease Journal 1999;18(7):609‐13. - PubMed
Baldwin 1981 {published data only}
    1. Baldwin RJT, Cranfield R. A multi‐centre general practice trial comparing fucidin ointment and fucidin cream. British Journal of Clinical Practice 1981;35(4):157‐60. - PubMed
Ballantyne 1982 {published data only}
    1. Ballantyne F. Cefadroxil in the treatment of skin and soft‐tissue infections. Journal of Antimicobial Chemotherapy 1982;10 Suppl B:143‐7. - PubMed
Bastin 1982 {published data only}
    1. Bastin R, Rapin M, Kernbaum S. Controlled study of pristinamycin versus oxacillin in staphylococcal infections [Etude clinique de l'activite anti‐staphylococcique de la pristinamycine et de l'oxacilline]. Pathologie et Biologie 1982;30(6 part 2):473‐5. - PubMed
Bernard 1997 {published data only (unpublished sought but not used)}
    1. Bernard P, Vaillant L, Martin C, Beylot C, Quentin R, Touron D. Pristinamycin versus oxacillin in the treatment of superficial pyoderma [Pristinamycine (Pyostacine 500) versus Oxacilline (Bristopen) dans le traitement des pyodermites superficielles]. Annales de Dermatologie et de Venereologie 1997;124:394‐9. - PubMed
Bin Jaafar 1987 {published data only}
    1. Jaafar RB, Pettit JHS, Gibson JR, Harvey SG, Marks P, Webster A. Trimethoprim‐polymyxin B sulfate cream versus fusidic acid cream in the treatment of pyodermas. International Journal of Dermatology 1987;26(1):60‐3. - PubMed
Burnett 1963 {published data only}
    1. Burnett WJ. The route of antibiotic administration in superficial impetigo. New England Journal of Medicine 1963;268:72‐5. - PubMed
Cassels‐Brown 1981 {published data only}
    1. Cassels‐Brown G. A comparative study of fucidin ointment and cicatrin cream in the treatment of impetigo. British Journal of Clinical Practice 1981;35(4):153‐5. - PubMed
Colin 1988 {published data only}
    1. Colin M, Avon P. Comparative double‐blind evaluation of a new topical antibacterial agent, mupirocin, compared with placebo in the treatment of skin and soft tissue infections [Evaluation comparative double aveugle du nouvel agent antibactérien topique, la mupirocine, par rapport à un placebo dans le traitement des infections de la peau et des tussus mous]. Pharmatherapeutica 1988;5(3):198‐203. - PubMed
Cordero 1976 {published data only}
    1. Cordero A. Treatment of skin and soft‐tissue infections with cefadroxil, a new oral cephalosporin. Journal of International Medical Research 1976;4(3):176‐8. - PubMed
De Waard 1967 {published data only}
    1. Waard F, Nelemand FA. The treatment of impetigo with a very long‐acting sulpha drug [De behandeling van impetigo met een zeer lang werkend sulfapreparaat]. Huisarts en Wetenschap 1967;10:383‐387.
Dillon 1970 {published data only}
    1. Dillon HC. The treatment of streptococcal skin infections. Journal of Pediatrics 1970;76(5):676‐84. - PubMed
Dillon 1979a {published data only}
    1. Dillon HC, Gray BM, Ware JC. Clinical and laboratory studies with cefaclor: efficacy in skin and soft‐tissue infections. Postgraduate Medical Journal 1979;55 Suppl 4:77‐81. - PubMed
Drehobl 1997 {published data only (unpublished sought but not used)}
    1. Drehobl M, Koenig L, Barker M, St‐Clair P, Maladorno D. Fleroxacin 400 mg once daily versus ofloxacin 400 mg twice daily in skin and soft‐tissue infections. Chemotherapy 1997;43(5):378‐84. - PubMed
el Mofty 1990 {published data only}
    1. Mofty M, Harvey SG, Gibson JR, Calthrop JG, Marks P. Trimethoprim‐polymyxin B sulphate cream compared with fusidic acid cream in the treatment of superficial bacterial infection of the skin. Journal of International Medical Research 1990;18(2):89‐93. - PubMed
Esterly 1970 {published data only}
    1. Esterly NB, Markowitz M. The Treatment of Pyoderma in Children. JAMA 1970;212(10):1667‐70. - PubMed
Faingezicht 1992 {published data only}
    1. Faingezicht I, Bolanos HJ, Arias G, Guevara J, Ruiz M. Comparative study of cefprozil and cefaclor in children with bacterial infections of skin and skin structures. Pediatric Infectious Diseases Journal 1992;11(11):976‐8. - PubMed
Fedorovskaia 1989 {published data only}
    1. Federovskaia RF, Bukharovich AM, Danilova TN, Masyukova SA, Blinova MY. Tomicide paste in combined therapy of pyoderma [Opyt primeneniia tomitsidovoi pasty v kompleksnoi terapii bol'nykh piodermiiami]. Vestnik Dermatologii i Venerologii 1989;9:63‐6. - PubMed
Fleisher 1983 {published data only}
    1. Fleisher GR, Wilmott CM, Campos JM. Amoxicillin combined with clavulanic acid for the treatment of soft‐tissue infections in children. Antimicrobial Agents & Chemotherapy 1983;24(5):679‐81. - PMC - PubMed
Forbes 1952 {published data only}
    1. Forbes MA. A clinical evaluation of neomycin in different bases. Southern Medical Journal 1952;45(3):235‐9. - PubMed
Free 2006 {published data only}
    1. Free A, Roth E, Dalessandro M, Hiram J, Scangarella N, Shawar R, et al. Retapamulin ointment twice daily for 5 days vs oral cephalexin twice daily for 10 days for empiric treatment of secondarily infected traumatic lesions of the skin. Skinmed 2006;5(5):224‐32. - PubMed
Gentry 1985 {published data only}
    1. Gentry LO. Treatment of skin, skin structure, bone, and joint infections with ceftazidime. American Journal of Medicine 1985;79(Suppl 2a):67‐74. - PubMed
Gibbs 1987 {published data only}
    1. Gibbs DL, Kashin P, Jevons S. Comparative and non‐comparative studies of the efficacy and tolerance of tioconazole cream 1% versus another imidazole and/or placebo in neonates and infants with candidal diaper rash and/or impetigo. Journal of International Medical Research 1987;15(1):23‐31. - PubMed
Golcman 1997 {published data only (unpublished sought but not used)}
    1. Golcman B, Tuma SR, Golcman R, Schalka S, Gonzalez MA. Efficacy and safety of cefprozil and cefaclor on cutaneous infections. Anais Brasileiros de Dermatologia 1997;72(1):79‐82.
Goldfarb 1987 {published data only}
    1. Goldfarb J, Aronoff SC, Jaffe A, Reed MD, Blumer JL. Sultamicillin in the treatment of superficial skin and soft tissue infections in children. Antimicrobial Agents & Chemotherapy 1987;31(4):663‐4. - PMC - PubMed
Gooch 1991 {published data only}
    1. Gooch WM, Kaminester L, Cole GW, Binder R, Morman MR, Swinehart JM, et al. Clinical comparison of cefuroxime axetil, cephalexin and cefadroxil in the treatment of patients with primary infections of the skin or skin structures. Dermatologica 1991;183(1):336‐43. - PubMed
Hanfling 1992 {published data only}
    1. Hanfling MJ, Hausinger SA, Squires J. Loracarbef versus cefaclor in pediatric skin and skin structure infections. Pediatric Infectious Disease Journal 1992;11 Suppl 8:27‐30. - PubMed
Harding 1970 {published data only}
    1. Harding JW, Path MRC. General practitioners' forum. Flucloxacillin in the treatment of skin and soft‐tissue infections. Practioner 1970;205(230):801‐6. - PubMed
Heskel 1992 {published data only}
    1. Heskel NS, Siepman NC, Pichotta PJ, Green E M, Stoll RW. Erythromycin versus cefadroxil in the treatment of skin infections. International Journal of Dermatology 1992;31(2):131‐3. - PubMed
Jacobs 1992 {published data only}
    1. Jacobs RF, Brown WD, Chartrand S, Darden P, Drehobl MA, Yetman R, et al. Evaluation of cefuroxime axetil and cefadroxil suspensions for treatment of pediatric skin infections. Antimicrobial Agents & Chemotherapy 1992;36(8):1614‐8. - PMC - PubMed
Jennings 1999 {published data only}
    1. Jennings MB, Alfieri D, Kosinski M, Weinberg JM. An investigator‐blind study of the efficacy and safety of azithromycin versus cefadroxil in the treatment of skin and skin structure infections of the foot. The Foot: International Journal of Clinical Foot Science 1999;9(2):68‐72.
Jennings 2003 {published data only}
    1. Jennings MB, McCarty JM, Scheffler NM, Puopolo AD, Rothermel CD. Comparison of azithromycin and cefadroxil for the treatment of uncomplicated skin and skin structure infections. Cutis 2003;72(3):240‐4. - PubMed
Keeny 1979 {published data only}
    1. Keeney RE, Seamans ML, Russo RM, Gururaj VJ, Alle JE. The comparative efficacy of minocycline and penicillin‐V in Staphylococcus aureus skin and soft‐tissue infections. Cutis 1979;23(5):711‐8. - PubMed
Kotrajaras 1973 {published data only}
    1. Kotrajaras, R. Studies of bacterial infections of skin in Bangkok. International Journal of Dermatology 1973;12(3):163‐5. - PubMed
Kumakiri 1988 {published data only}
    1. Kumakiri M, Yasui C, Ohkawara A. Clinical study on TE‐031 tablet in dermatology. Chemotherapy 1988;36(Suppl 3):935‐7.
Kumar 1988 {published data only}
    1. Kumar A, Murray DL, Hanna CB, Kreindler TG, Jacobson KD, McCall Bundy J, et al. Comparitive study of cephalexin hydrochloride and cephalexin monohydrate in the treatment of skin and soft‐tissue infections. Antimicrobial Agents & Chemotherapy 1988;32(6):882‐5. - PMC - PubMed
Lassus 1990 {published data only}
    1. Lassus A. Comparative studies of azithromycin in skin and soft‐tissue infections and sexually transmitted infections by Neisseria and Chlamydia species. Journal of Antimicrobial Chemotherapy 1990;25 Supp A:115‐21. - PubMed
Lentino 1984 {published data only}
    1. Lentino JR, Stachowski M, Strikas R, Parrillo P. Comparative efficacy of cefotiam versus cephalotin in the therapy of skin and soft‐tissue infections. Antimicrobial Agents & Chemotherapy 1984;25(6):778‐80. - PMC - PubMed
Levenstein 1982 {published data only}
    1. Levenstein JH. Efficacy and tolerability of an amoxycillin/clavulanic acid combination in the treatment of common bacterial infections. A general practitioner trial. South African Medical Journal (Suid‐Afrikaanse Tydskrif Vir Geneeskunde) 1982;62(5 Spec No):16A‐20A. - PubMed
Lewis‐Jones 1985 {published data only}
    1. Lewis‐Jones S, Hart CA, Vickers CFH. Bactroban ointment versus fusidic acid in acute primary skin infections in children. Bactroban. Proceedings of an International Symposium; 1984 May 21‐22; Nassau, Bahama Islands. 1985:103‐8.
Linder 1978 {published data only}
    1. Linder CW. Treatment of impetigo and ecthyma. Journal of Family Practice 1978;7(4):697‐700. - PubMed
Linder 1993 {published data only}
    1. Linder CW, Nelson K, Paryani S, Stallworth JR, Blumer JL. Comparative evaluation of cefadroxil and cephalexin in children and adolescents with pyodermas. Clinical Therapeutics 1993;15(1):46‐56. - PubMed
Lipets 1987 {published data only}
    1. Lipets ME, Gnidenko VV. Gentamycin ointment in the therapy of impetigo in children [Gentamitsinovaia maz' v terapii impetigo u detei]. Pediatriia 1987;9:103. - PubMed
Liu 1986 {published data only}
    1. Liu ZL, Jiang ZP. Comparison between the curative effect of traditional Chinese medicine and Western medicine in child impetigo herpetiformis. Chinese Journal of Integrated Traditional & Western Medicine 1986;6(9):566‐6.
MacKenna 1945 {published data only}
    1. MacKenna RMB, Cooper‐Willis ES. Impetigo contagiosa in the army, treated with microcrystalline sulphathiazole. Lancet 1945;246(6363):357‐8.
Macotela‐Ruiz 1988 {published data only (unpublished sought but not used)}
    1. Macotela‐Ruiz E, Duran‐Bermudez H, Kuri‐Con FJ, Arevalo‐Lopez A, Villalobos‐Ibarra JL. Evaluation of the efficacy and toxicity of local fusidic aid versus oral dicloxacillin in infections of the skin [Evaluacion de la eficacia y toxicidad del acido fusidico local frente a dicloxacilina oral en infecciones de la piel]. Medicina Cutanea Ibero‐latino‐americana 1988;16(2):171‐3. - PubMed
Mallory 1991 {published data only}
    1. Mallory SB. Azithromycin compared with cephalexin in the treatment of skin and skin structure infections. American Journal of Medicine 1991;91 Suppl 3A:36‐9. - PubMed
Manaktala 2009 {published data only}
    1. Manaktala C, Singh AK, Verma M, Sachdeva A, Sharma J, Roy A, et al. Efficacy and tolerability of cefditoren pivoxil in uncomplicated skin and skin structure infections in Indian patients. Indian Journal of Dermatology 2009;54(4):350‐6. - PMC - PubMed
McCarty 1992 {published data only}
    1. McCarty J, Ruoff GE, Jacobson KD. Loracarbef (LY163892) versus cefaclor in the treatment of bacterial skin and skin structure infections in an adult population. American Journal of Medicine 1992;92 Suppl 6A:80‐5. - PubMed
McMillan 1969 {published data only}
    1. McMillan R, Hurwitz R. Tropical bacterial pyoderma in Vietnam. An improved therapeutic regimen. JAMA 1969;210(9):1734‐6. - PubMed
Milidiú d Silva 1985 {published data only}
    1. Milidiú da Silva I, Silva SCL. The evaluation of Bactroban ointment in the treatment of dermatological infections. Bactroban. Proceedings of an International Symposium; 1984 May 21‐22; Nassau, Bahama Islands. 1985:162‐5.
Nakayama 1983 {published data only}
    1. Nakayama I, Akieda Y, Watanabe T, Suzuki T, Itokawa K. Clinical investigation of a long‐acting amoxicillin preparation in patients with skin and soft‐tissue infections in surgery. Japanese Journal of Antibiotics 1983;36(5):1137‐63. - PubMed
Neldner 1991 {published data only}
    1. Neldner KH. Double‐blind randomized study of oral temafloxacin and cefadroxil in patients with mild to moderately severe bacterial skin infections. American Journal of Medicine 1991;91 Suppl 6A:111‐4. - PubMed
Nichols 1997 {published data only}
    1. Nichols RL, Smith JW, Gentry LO, Gezon J, Campbell T, Sokol P, et al. Multicenter, randomized study comparing levofloxacin and ciprofloxacin for uncomplicated skin and skin structure infections. Southern Medical Journal 1997;90(12):1193‐200. - PubMed
Nicolle 1990 {published data only}
    1. Nicolle LE, Postl B, Urias B, Ling N, Law B. Outcome following therapy of group A streptococcal infection in schoolchildren in isolated northern communities. Canadian Journal of Public Health 1990;81(6):468‐70. - PubMed
Nolting 1992 {published data only}
    1. Nolting S, Bräutigam M. Clinical relevance of the antibacterial activity of terbinafine: a contrallateral comparison between 1% terbinafine cream and 0.1% gentamicin sulphate cream in pyoderma. British Journal of Dermatology 1992;126(39):56‐60. - PubMed
Orecchio 1986 {published data only}
    1. Orecchio RM, Mischler TW. A double‐blind multiclinic comparative trial of mupirocin topical and its vehicle in the treatment of bacterial skin infections. Current Therapeutic Research 1986;39(1):82‐6.
Pakrooh 1978 {published data only}
    1. Pakrooh H. A comparison of sodium fusidate ointment ('Fucidin') alone versus oral antibiotic therapy in soft‐tissue infections. Current Medical Research & Opinion 1977‐78;5(4):289‐94. - PubMed
Palazzini 1993 {published data only}
    1. Palazzini E, Palmerio B. Treatment of pyogenic skin infections with rifaximin cream. European Review for Medical & Pharmacological Sciences 1993;15(2):87‐92. - PubMed
Parish 1984 {published data only}
    1. Parish LC, Aten EM. Treatment of skin and skin structure infections: a comparative study of augmentin and cefaclor. Therapeutics for the Clinician 1984;34(6):567‐70. - PubMed
Parish 1991 {published data only}
    1. Parish LC, Jungkind DL. Systemic antimicrobial therapy in skin and skin structure infections: comparison of temafloxacin and ciprofloxacin. American Journal of Medicine 1991;91 Suppl 6A:115‐9. - PubMed
Parish 1992 {published data only}
    1. Parish LC, Doyle CA, Durham SJ, Wilber RB. Cefprozil versus cefaclor in the treatment of mild to moderate skin and skin‐structure infections. Clinical Therapeutics 1992;14(3):458‐69. - PubMed
Parish 1997 {published data only}
    1. Parish LC, Doyle CA, Durham SJ, Wilber RB. Cefprozil versus cefaclor in the treatment of mild to moderated skin and skin‐structure infections [Cefprozil versus cefaclor no tratamento de infeccoes leves a moderadas da pele e estruturas da pele]. Revista Brasileira de Medicina 1997;54(5):342‐50.
Parish 2000 {published data only}
    1. Parish LC, Routh HB, Miskin B, Fidelholtz J, Werschler P, Heyd A, et al. Moxifloxacin versus cephalexin in the treatment of uncomplicated skin infections. International Journal of Clinical Practice 2000;54(8):497‐503. - PubMed
Parish 2006 {published data only}
    1. Parish LC, Jorizzo JL, Breton JJ, Hirman JW, Scangarella NE, Shawar RM. Topical retapamulin ointment (1%, wt/wt) twice daily for 5 days versus oral cephalexin twice daily for 10 days in the treatment of secondarily infected dermatitis: results of a randomized controlled trial. Journal of the American Academy of Dermatology 2006;55(6):1003‐13. - PubMed
Park 1993 {published data only}
    1. Park SW, Wang HY, Sung HS. A study for the isolation of the causative organism, antimicrobial susceptibility tests and therapeutic aspects in patients with impetigo. Korean Journal of Dermatology 1993;31(3):312‐9.
Pien 1983 {published data only}
    1. Pien FD. Double‐blind comparative study of two‐dosage regimens of cefaclor and amoxicillin‐clavulanic acid in the outpatient treatment of soft‐tissue infections. Antimicrobial Agents & Chemotherapy 1983;24(6):856‐9. - PMC - PubMed
Powers 1991 {published data only}
    1. Powers RD, Schwartz R, Snow RM, Yarbrough III DR. Ofloxacin versus cephalexin in the treatment of skin, skin structure, and soft‐tissue infections in adults. Clinical Therapeutics 1991;13(6):727‐36. - PubMed
Powers 1993 {published data only}
    1. Power RD. Open trial of oral fleroxacin versus amoxicillin/clavulanate in the treatment of infections of skin and soft tissue. American Journal of Medicine 1993;94 Suppl 3A:155‐8. - PubMed
Pusponegoro 1990 {published data only}
    1. Pusponegoro EHD, Wiryadi BE. Clindamycin and cloxacillin compared in the treatment of skin and soft‐tissue infections. Clinical Therapeutics 1990;12(3):236‐41. - PubMed
Risser 1985 {published data only}
    1. Risser WL, Kaplan SL, Mason EO, Listernick R, Yogev R, Pickering LK. Treatment of soft‐tissue infections in children with amoxicillin‐clavulanic combination or cefaclor. Current Therapeutic Research‐Clinical and Experimental 1985;37(4):747‐53.
Saenz 1985 {published data only}
    1. Saenz C, Garcia‐Estrada E. Controlled clinical trial of Bactroban ointment in the treatment of skin infections. Excerpta Medica Current Clinical Practice Series 1985;16:205‐10.
Salzberg 1972 {published data only}
    1. Salzberg R. Comparative clinical and bacteriological studies with Bactrim and ampicillin in the pediatrics [Vergleichende klinische und bakteriologische Untersuchungen mit Bactrim und Ampicillin in der pädiatrischen Praxis]. Schweizerische Rundschau fur Medizin Praxis / Revue Suisse de Medecine Praxis 1972;61(33):1051‐2. - PubMed
Schupbach 1992 {published data only}
    1. Schupbach CW, Olovich KG, Dere WH. Efficacy of cefaclor AF in the treatment of skin and skin structure infections. Clinical Therapeutics 1992;14(3):470‐9. - PubMed
Schwartz 1996 {published data only}
    1. Schwartz R, Das‐Young LR, Ramirez‐Ronda C, Frank E. Current and future management of serious skin and skin‐structure infections. American Journal of Medicine 1996;100 Suppl 6A:91‐5. - PubMed
Smith 1985 {published data only}
    1. Smith JH, Gould JC. Placebo‐controlled study of Bactroban ointment in patients attending general practice. Bactroban. Proceedings of an International Symposium; 1984 May 21‐22; Nassau, Bahama Islands. 1985:130‐6.
Smith 1993 {published data only}
    1. Smith JW, Nichols RL. Comparison of oral fleroxacin with oral amoxicillin/clavulanate for treatment of skin and soft‐tissue infections. American Journal of Medicine 1993;94 Suppl 3A:150‐4. - PubMed
Sobye 1966 {published data only}
    1. Sobye P. Cutaneous Staphylococcus aureus infection treated with fucidin ointment [Kutane Staphylococcus aureus infektioner behandlet med fugidinsalve]. Ugeskrift for Laeger 1966;128(7):204‐7. - PubMed
Stevens 1993 {published data only}
    1. Stevens DL, Pien F, Drehobl M. Comparison of oral cefpodoxime proxetil and cefaclor in the treatment of skin and soft‐tissue infections. Diagnostic Microbiology & Infectious Disease 1993;16(2):123‐29. - PubMed
Tack 1991 {published data only}
    1. Tack KJ, Wilks NE, Sermdikian G, Frazier CH, Shirin K, Puoipolo A, et al. Cefpodoxime proxetil in the treatment of skin and soft‐tissue infections. Drugs 1991;42 Suppl 3:51‐6. - PubMed
Török 2004 {published data only}
    1. Török E, Somogyi T, Rutkai K, Iglesias L, Bielsa I. Fusidic acid suspension twice daily: a new treatment schedule for skin and soft tissue infection in children, with improved tolerability. Journal of Dermatological Treatment 2004;15(3):158‐63. - PubMed
Urbach 1966 {published data only}
    1. Urbach F. Combined chemotherapy in the treatment of superficial bacterial infections of the skin. Current Therapeutic Research 1966;8(4):199‐202. - PubMed
Van der Auwera 1985 {published data only}
    1. Auwera P, Klastersky J, Thys JP, Meunier‐Carpentier F, Legrand JC. Double‐blind, placebo‐controlled study of oxacillin combined with rifampin in the treatment of staphylococcal infections. Antimicrobial Agents & Chemotherapy 1985;28(4):467‐72. - PMC - PubMed
Villiger 1986 {published data only}
    1. Villiger JW, Robertson WD, Kanki K, Ah Chan M, Fetherston J, Hague IK, et al. A comparison of the new topical antibiotic mupirocin (Bactroban) with oral antibiotics in the treatment of skin infections in general practice. Current Medical Research & Opinion 1986;10(5):339‐45. - PubMed
Wachs 1992 {published data only}
    1. Wachs GN, Nolen TM, Parish LC, Morman MR, Cleaver L, Ginsberg D. Comparison of cefadroxil and amoxicillin/clavulanate in mild to moderate skin and skin‐structure infections. Advances in Therapy 1992;9(2):69‐80.
Wible 2003 {published data only}
    1. Wible K, Tregnaghi M, Bruss J, Fleishaker D, Naberhuis‐Stehouwer S, Hilty M. Linezolid versus cefadroxil in the treatment of skin and skin structure infections in children. Pediatric Infectious Disease Journal 2003;22(4):315‐23. - PubMed
Wolbling 1987 {published data only}
    1. Wölbling RH, Schäfer V. Treatment of impetiginized eczema with prednicarbate in combination with a quarternary ammonium salt [Zur Behandlung des impetiginisierten Ekzems mit Prednicarbat in Kombination mit einem quarternären Ammoniumsalz]. Arzneimittelforschung 1987;37(2):218‐20. - PubMed
Wong 1989 {published data only}
    1. Wong KS, Lim KB, Tham SN, Ling ML, Tan T. Comparative double‐blinded study between mupirocin and tetracycline ointments for treating skin infections. Singapore Medical Journal 1989;30(4):380‐3. - PubMed
Yura 1988 {published data only}
    1. Yura J, Shinagawa N, Mizuno A, Watanabe S, Ando M, Sakai K, et al. Clinical evaluation of cefpodoxime proxetil in the treatment of skin and soft‐tissue infections. Japanese Journal of Antibiotics 1988;41(10):1517‐37. - PubMed

References to studies awaiting assessment

Chen 2011 {published data only}
    1. Chen AE, Carroll KC, Diener‐West M, Ross T, Ordun J, Goldstein MA, et al. Randomized controlled trial of cephalexin versus clindamycin for uncomplicated pediatric skin infections. Pediatrics 2011;127(3):e573‐80. - PMC - PubMed
Chosidow 2005 {published data only}
    1. Chosidow O, Bernard P, Berbis P, Humbert P, Crickx B, Jarlier V, et al. Cloxacillin versus pristinamycin for superficial pyodermas: A randomized, open‐label, non‐inferiority study. Dermatology 2005;210(4):370‐4. - PubMed
Davies 1945 {published data only}
    1. Davies JH, Dixon K, Stuart‐Harris CH. A therapeutic trial of penicillin in infective conditions of the skin. Quarterly Journal of Medicine 1945;14(Oct):183‐96. - PubMed
Ghosh 1995 {published data only}
    1. Ghosh SK. A study on the role of neem, haldi, sajina and garlic oil (Nutriderm Oil) in pyoderma and infective dermatitis. Indian Journal of Dermatology 1995;40(2):73‐5.
Gubelin 1993 {published data only}
    1. Gübelin HW, Zegpi E, Oroz MJ, Canto ETM, Pérez J, Grandi P, et al. Comparative clinique study of topical mupirocine and oral cloxacillin in the treatment of skin infections [Estudio clínico comparativo de mupirocine tópico y cloxacilina oral en el tratamiento de infecciones cutáneas]. Dermatología (Santiago de Chile) 1993;9(2):78‐83.
Kar 1988 {published data only}
    1. Kar PK. A study of treatment of pyoderma with injection benzathine penicillin. Journal of the Indian Medical Association 1988;86(1):8‐11. - PubMed
Kar 1996 {published data only}
    1. Kar PK. A combination of amoxicillin and clavulanic acid in the treatment of pyoderma in children. Indian Journal of Dermatology Venereology & Leprology 1996;62(2):91‐4. - PubMed
Luby 2002 {published data only}
    1. Luby S, Agboatwalla M, Schnell BM, Hoekstra RM, Rahbar MH, Keswick BH. The effect of antibacterial soap on impetigo incidence, Karachi, Pakistan. American Journal of Tropical Medicine & Hygiene 2002;67(4):430‐5. - PubMed
Menendez 2007 {published data only}
    1. Menéndez S, Fernández M, Amoroto M, Uranga R, Acuña P, Elisa Benítez J, et al. Efficacy and security of topical OLEOZON in the treatment of patients with impetigo [Eficacia y seguridad del OLEOZON tópico en el tratamiento de pacientes con impétigo]. Revista Panamericana de Infectología 2007;9(2):23‐9.
Motohiro 1992 {published data only}
    1. Motohiro T, Aramaki M, Oda, K, Kawakami A, Koga T, Tomita S, et al. Clinical studies on cefprozil granules in pediatric skin soft tissues infections [[unknown]]. Japanese Journal of Antibiotics 1992;45(12):1684‐99. - PubMed
Pierard‐Franchimont 2008 {published data only}
    1. Pierard‐Franchimont CHF, Szepetiuk G, Devillers C, Pierard GE. Comparative randomized intraindividual assessment of the efficacy of fusidic acid and povidone iodine in impetigo. Current Topics in Pharmacology 2008;12(2):113‐7.
Sharquie 2000 {published data only}
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References to ongoing studies

ACTRN12609000858291 {published data only}
    1. ACTRN12609000858291. An open label randomised controlled trial to determine if 5 days of once‐daily oral trimethoprim‐sulfamethoxazole or three days of twice‐daily oral trimethoprim‐sulfamethoxazole will lead to non‐inferior cure rates of impetigo compared to a single dose of intramuscular benzathine penicillin G (the current gold standard treatment) in children living in remote Aboriginal communities between the age of 12 weeks to less than 13 years. www.anzctr.org.au/trial_view.aspx?id=83543 (accessed 3 August 2010).
CTRI/2008/091/000060 {published data only}
    1. CTRI/2008/091/000060. A clinical trial to study the safety and efficacy of combination drug, vancomycin and ceftriaxone compared to vancomycin in mild to severe bacterial infections. apps.who.int/trialsearch/trial.aspx?TrialID=CTRI/2008/091/000060 (accessed 3 August 2010).
NCT00202891 {published data only}
    1. NCT00202891. Sisomicin Cream Vs Nadifloxacin Cream in Primary Pyodermas (Study P04460)(TERMINATED). clinicaltrials.gov/ct2/results?term=NCT00202891 (accessed 3 August 2010).
NCT00626795 {published data only}
    1. NCT00626795. Efficacy, Safety, and Tolerability of TD1414 2% Cream in Impetigo and Secondarily Infected Traumatic Lesions (SITL). clinicaltrials.gov/ct2/show/NCT00626795?term=NCT00626795 (accessed 3 August 2010).
NCT00852540 {unpublished data only}
    1. 110978. A Randomized, Double‐Blind, Double Dummy, Comparative, Multicenter Study to Assess the Safety and Efficacy of Topical Retapamulin Ointment, 1%, versus Oral Linezolid in the Treatment of Secondarily‐Infected Traumatic Lesions and Impetigo Due to Methicillin‐Resistant Staphylococcus aureus. www.gsk‐clinicalstudyregister.com/protocol_detail.jsp?protocolId=110978&studyId=... (accessed 3 August 2010).
NCT00986856 {published data only}
    1. NCT00986856. Fucidin® Cream in the Treatment of Impetigo. clinicaltrials.gov/ct2/results?term=NCT00986856 (accessed 3 August 2010).
NCT01171326 {unpublished data only}
    1. NCT01171326. Study to evaluate the safety and efficacy of topical minocycline FXFM244 in impetigo patients. clinicaltrials.gov/ct2/results?term=NCT01171326 (accessed 11 July 2011).

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References to other published versions of this review

Koning 2003
    1. Koning S, Verhagen AP, Suijlekom‐Smit LWA, Morris AD, Butler C, Wouden JC. Interventions for impetigo. Cochrane Database of Systematic Reviews 2003, Issue 2. [DOI: 10.1002/14651858.CD003261] - DOI - PubMed

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