儿童脓疱病的治疗：共识与未来方向

Schachner Lawrence A, Torrelo Antonio, Grada Ayman, Micali Giuseppe, Kwong Pearl C, Scott Gwenolyn B, Benjamin Latanya, Gonzalez Mercedes E, Andriessen Anneke, Eberlein Thomas, Eichenfield Lawrence F

J Drugs Dermatol. 2020 Mar 1;19(3):281-290.

BACKGROUND

Impetigo is a common contagious superficial bacterial skin infection. Treatment of localized lesions can be achieved through topical antibiotics. Oral antibiotics are reserved for extensive disease. Increasing antimicrobial resistance to existing therapies have raised concerns. Antimicrobial stewardship, achieved through the responsible use of antibiotics, is an important measure to re-duce bacterial resistance. This review highlights treatment options for impetigo and shares consensus statements to help guide the management of impetigo in the pediatric population.

OBJECTIVE

An expert panel of dermatologists and pediatricians convened in February 2019 to establish evidence-based consensus on the management of impetigo in the pediatric patient population.

METHODS

The consensus was created in accordance with the Appraisal of Guidelines, Research and Evaluation (AGREE) II instrument. Prior to the consensus meeting, a systematic literature review was conducted, with the selected literature deemed clinically relevant to the consensus statements. Statements were further refined and assessed systematically following established standards. The consensus process consisted of a modified Delphi approach. The consensus was established through a minimal 75% “agree” rate.

RESULTS

Thirteen consensus statements were developed addressing clinical challenges, existing treatment options and their limita-tions, and new therapeutic alternatives.

CONCLUSION

Bacterial resistance to antimicrobials commonly used in treating impetigo has been reported. Antimicrobial stewardship is critical to optimize patient outcomes and to prevent the development of resistance. Healthcare providers should be aware of local resistance patterns in impetigo to help guide therapy. The use of newer safe and effective topical antibiotic alternatives as a first-line treatment should be an important step in antimicrobial stewardship.J Drugs Dermatol. 2020;19(3): doi:10.36849/JDD.2020.4679.

背景

脓疱病是一种常见的传染性浅表细菌性皮肤感染。局部病变的治疗可通过外用抗生素实现。口服抗生素则用于广泛病变。对现有疗法的抗菌耐药性不断增加引发了担忧。通过合理使用抗生素实现抗菌药物管理，是减少细菌耐药性的重要措施。本综述重点介绍脓疱病的治疗选择，并分享共识声明，以帮助指导儿科患者脓疱病的管理。

目的

2019年2月，皮肤科医生和儿科医生专家小组召开会议，就儿科患者脓疱病的管理建立基于证据的共识。

方法

根据《指南、研究与评价评估（AGREE）II工具》制定共识。在共识会议之前，进行了系统的文献综述，所选文献被认为与共识声明临床相关。声明根据既定标准进一步完善并进行系统评估。共识过程采用改良的德尔菲法。通过至少75%的“同意”率达成共识。

结果

制定了13项共识声明，涉及临床挑战、现有治疗选择及其局限性以及新的治疗替代方案。

结论

已报道细菌对治疗脓疱病常用抗菌药物产生耐药性。抗菌药物管理对于优化患者治疗效果和预防耐药性发展至关重要。医疗保健提供者应了解脓疱病的局部耐药模式，以帮助指导治疗。使用更新的安全有效的外用抗生素替代方案作为一线治疗，应是抗菌药物管理的重要一步。《药物皮肤病学杂志》。2020年；19（3）：doi:10.36849/JDD.2020.4679 。