Randomized clinical trial of topical mupirocin versus oral erythromycin for impetigo

Goldfarb, Johanna; Crenshaw, D A; O’Horo, John C.; Lemon, Eloise; Blumer, Jeffrey L.

doi:10.1128/aac.32.12.1780

Cited by 56 publications

(24 citation statements)

References 23 publications

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“…Of (9,12,13,18,21,22). More recently, many studies from various parts of the world showed that the predominant organism in the disease was S. aureus, isolated alone or with streptococci from 65 to 98% of the patients (1,5,7,8,14,16,19,20). Furthermore, failure rates with penicillin and amoxicillin were unacceptably high, ranging from 20 to 47% (1,7,8) and suggesting that S. aureus was not just an innocent bystander but rather played an important role in the disease as either a primary or a secondary pathogen.…”

Section: Resultsmentioning

confidence: 99%

“…Because of its activity against both streptococci and S. aureus, erythromycin is a widely used drug for impetigo and has been used as a "gold standard" for comparisons of topical and systemic treatments (3,5,11,(14)(15)(16). The susceptibility of S. aureus to erythromycin was not mentioned in most of these studies, but clinical response was adequate.…”

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confidence: 99%

“…For many years, impetigo had been considered a streptococcal disease (9,12,13,18,21,22). However, 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, whereas Streptococcus pyogenes was isolated in about one of three of the cases, usually with S. aureus (5,7,8,14,16,20). We and others have recently shown that in areas where S. aureus strains are usually penicillin resistant, a high rate of failure may occur if antistaphylococcal coverage is not provided by the therapeutic regimen, thus suggesting the role of S. aureus as a causative agent in impetigo (8,14).…”

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confidence: 99%

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Double-blind study comparing erythromycin and mupirocin for treatment of impetigo in children: implications of a high prevalence of erythromycin-resistant Staphylococcus aureus strains

Dagan

Bar-David

1992

Antimicrob Agents Chemother

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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 prospective double-blind controlled study comparing topical mupirocin with oral erythromycin to determine (i) the prevalence of erythromycinresistant 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. Erythromycinresistant 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. In view of the increasing resistance of S. aureus to various antibiotic drugs, new therapeutic regimens should be sought for this common skin infection. In our setting, mupirocin seems an appropriate alternative.

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Section: Resultsmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Double-blind study comparing erythromycin and mupirocin for treatment of impetigo in children: implications of a high prevalence of erythromycin-resistant Staphylococcus aureus strains

Dagan

Bar-David

1992

Antimicrob Agents Chemother

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“…In vitro, mupirocin exhibits a high level of activity against gram-positive cocci such as Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pyogenes, and other ␤-hemolytic streptococci (35), the pathogens most frequently encountered in primary and secondary skin infections. Initially formulated as 2% mupirocin ointment in a polyethylene glycol vehicle (Bactroban; SmithKline Beecham Pharmaceuticals), clinical usage over more than 10 years has demonstrated the efficacy and safety of mupirocin for treating primary and secondary skin infections (21,25,26,28; A. A. Hebert, D. L. Breneman, and C. E. Grier, Prog.…”

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confidence: 99%

Efficacy of a New Cream Formulation of Mupirocin: Comparison with Oral and Topical Agents in Experimental Skin Infections

Gisby

Bryant

2000

Antimicrob Agents Chemother

111

100

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A new cream formulation of mupirocin developed to improve patient compliance was compared with systemic and topical antibiotics commonly used to treat primary and secondary skin infections. A mouse surgical wound model infected with Staphylococcus aureus or Streptococcus pyogenes was used. Topical treatment was applied at 4 and 10 h postinfection or oral treatment at a clinically relevant dose was administered 4, 8, and 12 h postinfection; treatments were continued three times daily for a further 3 days. Mupirocin cream was significantly more effective than (P < 0.01; two of eight studies) or not significantly different from (six of eight studies) mupirocin ointment in reducing bacterial numbers. Mupirocin cream was similar in efficacy to oral flucloxacillin but significantly more effective (P < 0.001) than oral erythromycin. It was also similar in efficacy to cephalexin against S. pyogenes but superior against S. aureus (P < 0.01). Mupirocin cream had a similar efficacy to fusidic acid cream against S. aureus but was significantly superior against S. pyogenes (P < 0.01). A hamster impetigo model infected with S. aureus was also used. Topical or oral treatment was administered at 24 and 30 h postinfection (also 36 h postinfection for oral therapy) and then three times daily for a further 2 days. On day 5, mupirocin cream was significantly more effective than mupirocin ointment in one study (P < 0.01) and of similar efficacy in the other two studies. Mupirocin cream was not significantly different from fusidic acid cream or neomycin-bacitracin cream, but it was significantly superior (P < 0.01) to oral erythromycin and cephalexin. Mupirocin cream was as effective as, or superior to, oral and other topical agents commonly used for skin infections.

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“…[8][9][10][11][12][13][14][15][16] Aim of the Study On the basis of above mentioned data our aim of the study was to see whether its topical preparation has such efficacy or not. …”

Section: Introductionmentioning

confidence: 99%

Evaluation of the effect of topical cefadroxil on bacterial load of pathogenic staphylococci in anterior nares in human volunteers, comparative study between oral vs. topical cefadroxil

Shah

Mehta

Shah

et al. 2013

Int J Basic Clin Pharmacol

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Randomized clinical trial of topical mupirocin versus oral erythromycin for impetigo

Cited by 56 publications

References 23 publications

Double-blind study comparing erythromycin and mupirocin for treatment of impetigo in children: implications of a high prevalence of erythromycin-resistant Staphylococcus aureus strains

Double-blind study comparing erythromycin and mupirocin for treatment of impetigo in children: implications of a high prevalence of erythromycin-resistant Staphylococcus aureus strains

Efficacy of a New Cream Formulation of Mupirocin: Comparison with Oral and Topical Agents in Experimental Skin Infections

Evaluation of the effect of topical cefadroxil on bacterial load of pathogenic staphylococci in anterior nares in human volunteers, comparative study between oral vs. topical cefadroxil

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