Department of Dermatology, UTHealth McGovern Medical School, Houston, USA.
UTHealth McGovern Medical School, Houston, USA.
Expert Opin Drug Saf. 2021 Jun;20(6):677-683. doi: 10.1080/14740338.2021.1902502. Epub 2021 Apr 13.
Impetigo is a superficial bacterial skin infection largely affecting the pediatric population. The objective of this review is to provide a comparison of mechanism of action, efficacy and safety of the available topical antibiotics for impetigo.
Randomized clinical trials that evaluated the use of topical antibiotics for treatment of impetigo were included. Two thousand eighty-nine studies were initially identified, and five randomized clinical trials met the criteria for further analysis.
Topical antibiotics had greater resolution of impetigo in comparison to vehicle in these pivotal clinical trials. Adverse events were minimal, with the most common being pruritus at the application site. Cost or insurance coverage may be a limiting factor in choosing the best therapeutic agent, with mupirocin ointment having the lowest cost. Mupirocin has shown clinical efficacy against MRSA but a bacterial culture is recommended to rule out resistance. Ozenoxacin and retapamulin are effective alternatives but may entail higher cost. Retapamulin is indicated for lesions of impetigo that are colonized by MSSA and streptococcus S. pyogenes but not MRSA based on clinical efficacy of phase III trials. Fusidic acid, available in other countries, is a non-FDA approved medication although rising resistance rates represent a growing concern.
脓疱疮是一种主要影响儿童人群的浅层细菌性皮肤感染。本综述的目的是比较脓疱疮的现有局部抗生素的作用机制、疗效和安全性。
纳入了评估局部抗生素治疗脓疱疮的随机临床试验。最初确定了 2089 项研究，有 5 项随机临床试验符合进一步分析的标准。
在这些关键的临床试验中，与载体相比，局部抗生素能更有效地治疗脓疱疮。不良反应很少见，最常见的是在涂抹部位瘙痒。选择最佳治疗药物时，费用或保险覆盖范围可能是一个限制因素，莫匹罗星软膏的成本最低。莫匹罗星已显示出对 MRSA 的临床疗效，但建议进行细菌培养以排除耐药性。奥沙沙星和瑞他帕林是有效的替代药物，但可能费用更高。瑞他帕林适用于由 MSSA 和化脓性链球菌 S. pyogenes 定植但非 MRSA 引起的脓疱疮病变，这是基于 III 期临床试验的临床疗效。虽然耐药率的上升令人担忧，但在其他国家上市的夫西地酸是一种未获得 FDA 批准的药物。
