A randomized open label parallel group study comparing the safety, effectiveness and adherence between 2% fusidic acid cream versus 1% retapamulin ointment in children with impetigo
Keywords:Adherence, Fusidic acid, Infection rating scale, Retapamulin, Secondary impetigo, Skin
Background: Impetigo is a contagious bacterial skin infection that affects both adults and children. Topical antibacterials such as mupirocin and fusidic acid are the most commonly used in both primary and secondary impetigo. Clinical trials have shown high efficacy of retapamulin in the treatment of secondary impetigo. However, its use in primary impetigo is limited. To this purpose, we compared the safety, efficacy and adherence to treatment of fusidic acid with retapamulin in primary impetigo.
Methods: A total of 50 patients with a clinical diagnosis of primary impetigo, between 2-12 years of age, having <10 lesions, 3/5 signs and symptoms, skin infection rating score ≥4 and pus score ≥ one were involved. Patients who were having secondary impetigo leions were excluded. Twenty-five patients received 2% fusidic acid cream three times a day, and the remaining 25 patients received 1% retapamulin ointment two times a day for seven days. Skin Infection Rating Scale (SIRS) was used to assess the severity of disease at baseline and end of treatment. Clinical success was considered when SIRS score of zero each for pus, crust and pain and 0/1 each for erythema and itching. Clinical failure is a SIRS score of ≥1 for pus.
Results: Baseline disease characteristics such as a number of lesions, the severity of disease (SIRS) and pus scores were statistically similar between the two groups. The clinical improvement observed with both fusidic acid and Retapamulin (20/25, 80%) and (21/25, 84%) treatments was not statistically different (p>0.05). Both drugs were well tolerated.
Conclusions: Both fusidic and retapamulin showed similar clinical success in patients with primary impetigo. Since fusidic acid has anti-inflammatory property and its treatment is cost-effective, it can be considered as first-line treatment and retapamulin in fusidic acid-resistant impetigo.
Sladden MJ, Johnston GA. Common skin infections in children. BMJ. 2004;329(7457):95-9.
Brook I. Secondary bacterial infections are complicating skin lesions. J Med Microbiol. 2002;51(10):808-12.
Hahn RG, Knox LM, Forman TA. Evaluation of poststreptococcal illness. American family physician. 2005;71(10).
Koning S, van der Sande R, Verhagen AP, van Suijlekom-Smit LW, Morris AD, Butler CC, et al. Interventions for impetigo. The Cochrane database of systematic reviews. 2012 18;1:CD003261.
Koning S, van der Wouden JC. Treatment for impetigo: evidence favours topical treatment with mupirocin, fusidic acid. BMJ. 2004;329(7468):695.
Hunt E. Pleuromutilin antibiotics. Drugs Future. 2000;25(11):1163-8.
George A, Rubin G. A systematic review and meta-analysis of treatments for impetigo. Br J Gen Pract. 2003 Jun 1;53(491):480-7.
Pankuch GA, Lin G, Hoellman DB, Good CE, Jacobs MR, Appelbaum PC. Activity of retapamulin against Streptococcus pyogenes and Staphylococcus aureus evaluated by agar dilution, microdilution, E-test, and disk diffusion methodologies. Antimicrobial agents Chemotherapy. 2006;50(5):1727-30.
Gentry DR, Rittenhouse SF, McCloskey L, Holmes DJ. Stepwise exposure of Staphylococcus aureus to pleuromutilins is associated with stepwise acquisition of mutations in rplC and minimally affects susceptibility to retapamulin. Antimicro Agents Chemother. 2007;51(6):2048-52.
Jones RN, Fritsche TR, Sader HS, Ross JE. Activity of retapamulin (SB-275833), a novel pleuromutilin, against selected resistant gram-positive cocci. Antimicrobial agents and chemotherapy. 2006;50(7):2583-6.
Schöfer H, Simonsen L. Fusidic acid in dermatology: an updated review. Euro J Dermatol. 2010;20(1):6-15.
Morley P, Munot L. A comparison of sodium fusidate ointment and mupirocin ointment in superficial skin sepsis. Current Med Res Opinion. 1988;11(2):142-8.
Oranje AP, Chosidow O, Sacchidanand S, Todd G, Singh K, Scangarella N, et al. Topical retapamulin ointment, 1%, versus sodium fusidate ointment, 2%, for impetigo: a randomized, observer-blinded, noninferiority study. Dermatology (Basel, Switzerland). 2007;215(4):331-40.
Mandell LA. Mandell GL BJ, Dolin R. Fusidic acid. Principles and practice of infectious diseases. 7th ed. Philadelphia: Churchill Livingstone; 2010:355-358.
Koning S, van Suijlekom-Smit LW, Nouwen JL, Verduin CM, Bernsen RM, Oranje AP, et al. Fusidic acid cream in the treatment of impetigo in general practice: double blind randomised placebo controlled trial. BMJ. 2002 26;324(7331):203-6.
Koning S, van der Wouden JC, Chosidow O, Twynholm M, Singh KP, Scangarella N, et al. Efficacy and safety of retapamulin ointment as treatment of impetigo: randomized double-blind multicentre placebo-controlled trial. British J Dermatol. 2008;158(5):1077-82.
Watkins P. Impetigo: aetiology, complications and treatment options. Nursing Standard. 2005;19(36):50.