Expert Opin Drug Saf. 2021 Mar 16. doi: 10.1080/14740338.2021.1902502. Online ahead of print.
INTRODUCTION: Impetigo is a superficial bacterial skin infection largely affecting the pediatric population. The objective of this review was to provide a comparison of mechanism of action, efficacy and safety of the available topical antibiotics for impetigo.
AREAS COVERED: Randomized clinical trials that evaluated the use of topical antibiotics for treatment of impetigo were included. 2,089 studies were initially identified, and 5 randomized clinical trials met the criteria for further analysis.
EXPERT OPINION: Topical antibiotics had greater resolution of impetigo in comparison to vehicle in the pivotal clinical trials in which these medications were evaluated. Adverse events were minimal, with the most common adverse event 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 retapmulin 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.