A systematic review and meta-analysis of treatments for impetigo.
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.


OBJECTIVE
To determine the most effective treatment for impetigo in a systemically well patient.


METHODS
Systematic review and meta-analysis.


METHODS
Databases were searched for relevant studies. The Cochrane highly sensitive randomised controlled trial (RCT) search string was employed and combined with the word 'impetigo' as the MeSH term and keyword. The bibliographies of relevant articles were searched for additional references. RCTs that were either double- or observer-blind, and involved systemically well patients of any age in either primary or secondary care settings, were included. Studies that selected patients on the basis of skin swab results were excluded, as were studies that were not in English. Cure or improvement of impetigo reported at seven to 14 days from start of treatment was the primary outcome measure. Meta-analysis was performed on homogeneous studies.


RESULTS
Three hundred and fifty-nine studies were identified, of which 16 met the inclusion criteria. Meta-analysis demonstrated that topical antibiotics are more effective than placebo (odds ratio [OR] = 2.69, 95% confidence interval [CI] = 1.49 to 4.86). There is weak evidence for the superiority of topical antibiotics over some oral antibiotics, such as erythromycin (OR = 0.48, 95% CI = 0.23 to 1.00). There is no significant difference between the effects of mupirocin and fusidic acid (OR = 1.76, 95% CI = 0.77 to 4.03).


CONCLUSIONS
This review found limited high-quality evidence to inform the treatment of impetigo. From that which is available, we would recommend the use of a topical antibiotic for a period of seven days in a systemically well patient with limited disease. Further research is needed on the role of flucloxacillin and non-antibiotic treatments for impetigo.
George
Ajay
A
Centre for Primary and Community Care, University of Sunderland, Benedict Building, St George's Way, Sunderland SR2 7BW. ajay.george@sunderland.ac.uk
Rubin
Greg
G
D000287:Administration, Topical; D000293:Adolescent; D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D004917:Erythromycin / Q000627:therapeutic use*; D005194:Family Practice; D005672:Fusidic Acid / Q000627:therapeutic use*; D006801:Humans; D007169:Impetigo / Q000188:drug therapy*; D007223:Infant; D007231:Infant, Newborn; D016712:Mupirocin / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
D005672:Fusidic Acid; D004917:Erythromycin; D016712:Mupirocin