Fusidic acid cream in the treatment of impetigo in general practice: double blind randomised placebo controlled trial.
OBJECTIVE
To test the hypothesis that fusidic acid would not increase the treatment effect of disinfecting with povidone-iodine alone in children with impetigo.


METHODS
Randomised placebo controlled trial.


METHODS
General practices in Greater Rotterdam.


METHODS
184 children aged 0-12 years with impetigo.


METHODS
Clinical cure and bacterial cure after one week.


RESULTS
After one week of treatment 55% of the patients in the fusidic acid group were clinically cured compared with 13% in the placebo group (odds ratio 12.6, 95% confidence interval 5.0 to 31.5, number needed to treat 2.3). After two weeks and four weeks the differences in cure rates between the two groups had become smaller. More children in the placebo group were non-compliant (12 v 5) and received extra antibiotic treatment (11 v 3), and more children in the placebo group reported adverse effects (19 v 7). Staphylococcus aureus was found in 96% of the positive cultures; no strains were resistant to fusidic acid.


CONCLUSIONS
Fusidic acid is much more effective than placebo (when both are given in combination with povidone-iodine shampoo) in the treatment of impetigo. Because of the low rate of cure and high rate of adverse events in the placebo group, the value of povidone-iodine in impetigo can be questioned.
Koning
Sander
S
Department of General Practice, University Hospital Rotterdam, Room Ff325, PO Box 1738, Erasmus University, 3000 DR Rotterdam, Netherlands.
van Suijlekom-Smit
Lisette W A
LW
Nouwen
Jan L
JL
Verduin
Cees M
CM
Bernsen
Roos M D
RM
Oranje
Arnold P
AP
Thomas
Siep
S
van der Wouden
Johannes C
JC
D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005194:Family Practice / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005672:Fusidic Acid / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007169:Impetigo / Q000188:drug therapy* / Q000382:microbiology; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D009824:Ointments; D011206:Povidone-Iodine / Q000627:therapeutic use; D013210:Staphylococcus / Q000302:isolation & purification; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000891:Anti-Infective Agents, Local; D009824:Ointments; D005672:Fusidic Acid; D011206:Povidone-Iodine