Published: 2019-02-23

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

Jeevimani Venkata Subba Reddy, Vijaya Mohan Rao, Buchineni Madhavulu, B. L. Kudagi, Pathapati Rama Mohan


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.


Adherence, Fusidic acid, Infection rating scale, Retapamulin, Secondary impetigo, Skin

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