Hall Leanne M, Gorges Hilary J, van Driel Mieke, Magin Parker, Francis Nick, Heal Clare F
College of Medicine and Dentistry, James Cook University, Mackay Clinical School, Mackay, QLD, Australia.
Primary Care Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.
Fam Pract. 2022 Jan 19;39(1):150-158. doi: 10.1093/fampra/cmab066.
Impetigo is a common superficial skin infection that affects people worldwide and is usually treated with antibiotics; therefore, its management has implications for global antibiotic stewardship.
This systematic review and narrative synthesis compares and contrasts international impetigo management guidelines.
Guidelines for treatment of impetigo that were produced by a national authority; available to primary care physicians; and published since 2008 were included. Following a comprehensive search strategy, data extraction from eligible studies was performed independently in duplicate. Details of antiseptic and antibiotic treatment; methicillin-resistant Staphylococcus aureus treatment; and conservative management and preventative measures were tabulated and analysed descriptively.
Fifty-one guidelines were included from 42 different countries. All guidelines recommended systemic antibiotics, 78% of these only for widespread lesions or failure of topical antibiotic treatment. The first-line systemic antibiotic treatment was restricted to narrow-spectrum options in 21 (41%) whilst 7 (14%) recommended only broad-spectrum antibiotics first-line. Thirty-four (67%) guidelines included recommendations for topical antibiotic use. Twenty guidelines (39%) did not mention antiseptic treatment for impetigo. Guidelines did not always provide clear indications for different treatment options.
Despite potentially equal efficacy to systemic antibiotics, only two-thirds of guidelines include topical antibiotic options. Many fail to include recommendations for non-antibiotic treatments such as antiseptics, preventative measures and conservative management, despite potential for antibiotic-sparing. Provision of clear definitions of disease severity and indications for treatment would enhance the ability of clinicians to adhere to recommendations.
PROSPERO CRD42018117770.
脓疱病是一种常见的浅表皮肤感染，全球各地的人都可能感染，通常用抗生素治疗；因此，其管理对全球抗生素管理具有重要意义。
本系统评价和叙述性综合分析比较并对比了国际脓疱病管理指南。
纳入国家权威机构制定的、可供初级保健医生使用且自2008年以来发表的脓疱病治疗指南。遵循全面的检索策略，由两名独立人员对符合条件的研究进行重复数据提取。将防腐剂和抗生素治疗、耐甲氧西林金黄色葡萄球菌治疗以及保守管理和预防措施的详细信息制成表格并进行描述性分析。
纳入了来自42个不同国家的51项指南。所有指南都推荐使用全身用抗生素，其中78%仅用于广泛病变或局部用抗生素治疗失败的情况。21项指南（41%）将一线全身用抗生素治疗限制为窄谱抗生素，而7项指南（14%）仅推荐一线使用广谱抗生素。34项指南（67%）包括局部用抗生素使用的建议。20项指南（39%）未提及脓疱病的防腐剂治疗。指南并非总是为不同的治疗选择提供明确的指征。
尽管局部用抗生素可能与全身用抗生素具有同等疗效，但只有三分之二的指南包括局部用抗生素选项。许多指南未纳入非抗生素治疗（如防腐剂、预防措施和保守管理）的建议，尽管这些措施有可能减少抗生素使用。提供明确的疾病严重程度定义和治疗指征将提高临床医生遵循建议的能力。
PROSPERO CRD42018117770。
