TY - JOUR
T1 - Emerging treatment strategies for Impetigo in Endemic and Nonendemic settings
T2 - A systematic review
AU - Gahlawat, Garima
AU - Tesfaye, Wubshet
AU - Bushell, Mary
AU - Abrha, Solomon
AU - Peterson, Gregory M.
AU - Mathew, Cynthia
AU - Sinnollareddy, Mahipal
AU - McMillan, Faye
AU - Samarawickrema, Indira
AU - Calma, Tom
AU - Chang, Aileen Y.
AU - Engelman, Daniel
AU - Steer, Andrew
AU - Thomas, Jackson
N1 - Funding Information:
Garima Gahlawat, Wubshet Tesfaye, Mary Bushell, Solomon Abrha, and Jackson Thomas conceived the study. Garima Gahlawat, Wubshet Tesfaye, Mary Bushell, Solomon Abrha, and Jackson Thomas contributed to the study design. Garima Gahlawat, Wubshet Tesfaye, Mary Bushell, Gregory M. Peterson, Solomon Abrha, and Jackson Thomas participated in literature searches, data acquisition, evidence synthesis and interpretation of findings. Garima Gahlawat, Wubshet Tesfaye, and Solomon Abrha were involved in critical appraisal of the studies. Garima Gahlwat, Wubshet Tesfaye, Mary Bushell and Jackson Thomas drafted the initial manuscript. Garima Gahlawat, Wubshet Tesfaye, Mary Bushell, Solomon Abrha, Gregory M. Peterson, Cynthia Mathew, Mahipal Sinnollareddy, Indira Samarawickrema, Tom Calma, Aileen Y. Chang, Daniel Engelman, Andrew Steer, and Jackson Thomas were involved in critical revision of the work for intellectual content and validation. Wubshet Tesfaye, Mary Bushell, and Jackson Thomas were involved in supervision of the work. All authors reviewed and approved the final manuscript. This research was partly supported by the Australian Government through the Medical Research Future Fund (MRFF) funding scheme (project ID APP1170357). The views expressed herein are those of the authors and are not necessarily those of the Australian Government or MRFF. The authors have indicated that they have no conflicts of interest regarding the content of this article.
Funding Information:
This research was partly supported by the Australian Government through the Medical Research Future Fund (MRFF) funding scheme (project ID APP1170357). The views expressed herein are those of the authors and are not necessarily those of the Australian Government or MRFF.
Publisher Copyright:
© 2021 The Authors
PY - 2021/6
Y1 - 2021/6
N2 - Purpose: Impetigo affects approximately 162 million children worldwide at any given time. Lack of consensus on the most effective treatment strategy for impetigo and increasing antibiotic resistance continue to drive research into newer and alternative treatment options. We conducted a systematic review to assess the effectiveness of new treatments for impetigo in endemic and nonendemic settings. Methods: We searched PubMed, MEDLINE, CINAHL, Web of Science, and Embase via Scopus for studies that explored treatments for bullous, nonbullous, primary, and secondary impetigo published between August 1, 2011, and February 29, 2020. We also searched online trial registries and hand-searched the reference lists of the included studies. We used the revised Cochrane risk of bias (version 2.0) tool for randomized trials and the National Heart, Lung, and Blood Institute for nonrandomized uncontrolled studies to assess the risk of bias. Findings: We included 10 studies that involved 6651 participants and reported on 9 treatments in the final analysis. Most clinical trials targeted nonbullous impetigo or did not specify this. The risk of bias varied among the studies. In nonendemic settings, ozenoxacin 1% cream appeared to have the strongest evidence base compared with retapamulin and a new minocycline formulation. In endemic settings, oral co-trimoxazole and benzathine benzylpenicillin G injection were equally effective in the treatment of severe impetigo. Mass drug administration intervention emerged as a promising public health strategy to reduce the prevalence of impetigo in endemic settings. Implications: This review highlights the limited research into new drugs used for the treatment of impetigo in endemic and nonendemic settings. Limited recent evidence supports the use of topical ozenoxacin or retapamulin for impetigo treatment in nonendemic settings, whereas systemic antibiotics and the mass drug administration strategy have evidence for use in endemic settings. Given the troubling increase in resistance to existing treatments, there is a clear need to ensure the judicious use of antibiotics and to develop new treatments and alternative strategies; this is particularly important in endemic settings. PROSPERO identifier: CRD42020173042.
AB - Purpose: Impetigo affects approximately 162 million children worldwide at any given time. Lack of consensus on the most effective treatment strategy for impetigo and increasing antibiotic resistance continue to drive research into newer and alternative treatment options. We conducted a systematic review to assess the effectiveness of new treatments for impetigo in endemic and nonendemic settings. Methods: We searched PubMed, MEDLINE, CINAHL, Web of Science, and Embase via Scopus for studies that explored treatments for bullous, nonbullous, primary, and secondary impetigo published between August 1, 2011, and February 29, 2020. We also searched online trial registries and hand-searched the reference lists of the included studies. We used the revised Cochrane risk of bias (version 2.0) tool for randomized trials and the National Heart, Lung, and Blood Institute for nonrandomized uncontrolled studies to assess the risk of bias. Findings: We included 10 studies that involved 6651 participants and reported on 9 treatments in the final analysis. Most clinical trials targeted nonbullous impetigo or did not specify this. The risk of bias varied among the studies. In nonendemic settings, ozenoxacin 1% cream appeared to have the strongest evidence base compared with retapamulin and a new minocycline formulation. In endemic settings, oral co-trimoxazole and benzathine benzylpenicillin G injection were equally effective in the treatment of severe impetigo. Mass drug administration intervention emerged as a promising public health strategy to reduce the prevalence of impetigo in endemic settings. Implications: This review highlights the limited research into new drugs used for the treatment of impetigo in endemic and nonendemic settings. Limited recent evidence supports the use of topical ozenoxacin or retapamulin for impetigo treatment in nonendemic settings, whereas systemic antibiotics and the mass drug administration strategy have evidence for use in endemic settings. Given the troubling increase in resistance to existing treatments, there is a clear need to ensure the judicious use of antibiotics and to develop new treatments and alternative strategies; this is particularly important in endemic settings. PROSPERO identifier: CRD42020173042.
KW - drug therapy
KW - group A Streptococcus
KW - impetigo
KW - MDA
KW - RCT
KW - Staphylococcus aureus
KW - systematic review
UR - http://www.scopus.com/inward/record.url?scp=85107126723&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85107126723&partnerID=8YFLogxK
U2 - 10.1016/j.clinthera.2021.04.013
DO - 10.1016/j.clinthera.2021.04.013
M3 - Review article
C2 - 34053699
AN - SCOPUS:85107126723
SN - 0149-2918
VL - 43
SP - 986
EP - 1006
JO - Clinical Therapeutics
JF - Clinical Therapeutics
IS - 6
ER -
