https://www-sciencedirect-com.york.ezproxy.cuny.edu/science/article/pii/S0149291821002083
Title: Emerging Treatment Strategies for Impetigo in Endemic and Nonendemic Settings: A Systematic Review
Citation: Bpharm, G. et al (2021). Emerging Treatment Strategies for Impetigo in Endemic and Nonendemic Settings: A Systematic Review, Clinical Therapeutics 6(43), 986-1006
The study used a systematic review to present an updated review of treatment strategies for impetigo. Although the research on impetigo treatments from the past 10 years is limited, a few alternatives have emerged that the article discusses. In non-endemic settings, topical drugs are used such as ozenoxacin, retapamulin, and a new minocycline formulation. RCTs that tested these drugs show that ozenoxacin 1% cream has the strongest evidence. This drug is a new nonfluorinated quinolone antibiotic that has superior efficacy without significant adverse effects when compared to a placebo. It has potent bacteriostatic and bactericidal properaties against gram-positive pathogens such as staph and strep. However, its clinical success rates are shown to be lower than those of retapamulin. The article concludes that the reason for this is really because ozenoxacin studies used more stringent criteria to define clinical success. Due to the findings, the US FDA approved ozenoxacin for use in 2017 for the treatment of impetigo.
Another topical agent evaluated in this systematic review is retapamulin, which is a new topical antibiotic from the pleuromutilin class. It has similar efficacy with ozenoxacin and was approved for use in 2007 for impetigo. One RCT compared 1% retapamulin ointment with oral linezolid and found it to be significantly effective but less effective than linezolid. Another RCT found it to be significantly effective in treating patients with MRSA impetigo. In addition, it was also shown to have a safe tolerability profile and therefore the evidence supports the use of the drug for the management of impetigo and other uncomplicated bacterial skin infections.
The only clinical trial that explored the treatment of impetigo in endemic areas was in Australia in children with nonbullous impetigo. The results of the study showd that oral cotrimoxazole for 3-5 days was as effective as benzathine benzylpenicillin injection for severe impetigo. However, when MRSA is uncommon, those injections are not recommended as first line, instead oral cloxacillin or cephalexin is the mainstay.
The implications of the study are that the significant prevalence of impetgip and the increase in antibiotic resistance, treatment choices are limited especially in impetigo caused by MRSA. The study supports the use of ozanoxacin for MRSA infection, and shows that it has a superior resistance profile when compared to other quinolones. Other topical antibiotics are also effective in the nonedemic setting, such as retapamulin as discussed. On the other hand, systemic antibiotics are more effective in the endemic settings. The rapid emergence of resistant bacteria across the world is endangering the clinical efficacy of antibiotics and highlights the need for judicious use of existing antimicrobials and the development of newer agents. Although the emergence of drugs such as ozenoxacin for impetigo treatment in nonendemic settings is a positive development, the findings are indicative of the clear need for research into finding tolerable and effective alternative treatments.
