A randomised open label comparative study evaluating the effectiveness, adherence and safety between 2% mupirocin ointment and 2% fusidic acid cream in children with impetigo

Authors

  • Ravichandran Velappan Department of Dermatology, Chengalpattu Medical College, Tamil Nadu, India
  • Sindhuja Ramasamy Department of Dermatology, Chengalpattu Medical College, Tamil Nadu, India
  • Shridhar Venu Department of Dermatology, Chengalpattu Medical College, Tamil Nadu, India
  • Muthusubramanian Chandrasekar Department of Dermatology, Chengalpattu Medical College, Tamil Nadu, India

DOI:

https://doi.org/10.18203/issn.2455-4529.IntJResDermatol20192095

Keywords:

Primary impetigo, Skin infection rating scale, Clinical failure, Anti inflammatory, Adherence

Abstract

Background: Impetigo is a superficial bacterial skin infection that affects mainly children, which is highly contagious. Topical anti-bacterials are most commonly used in both primary and secondary impetigo. Clinical trials have shown high efficacy of these topicals along with systemic antibiotics in both complicated and uncomplicated impetigo. However use of these topical modalities alone in uncomplicated primary impetigo is limited. The aim of the study was to compare the efficacy, safety and adherence to treatment of mupirocin with fusidic acid in primary impetigo.

Methods: A total of 60 patients with a clinical diagnosis of primary impetigo, between 2-14 years of age, having <10 lesions, skin infection rating score >4 and pus score equal to or more than one who attended Dermatology OPD, in Chengalpattu Medical College Hospital from February 2018 to March 2019. Study design was a comparative analytical study.

Results: Baseline disease characteristics such as number of lesions, the severity of disease (SIRS), and pus scores were statistically similar between the two groups. The clinical improvement observed with mupirocin (25/30) and fusidic acid (24/30) treatment in primary impetigo was not statistically significant (p>0.05). Both drugs were tolerated well.

Conclusions: Both mupirocin and fusidic acid showed similar clinical success in patients with primary impetigo. Though fusidic acid has additional anti-inflammatory property and its treatment is cost effective, but irritant effects observed in some patients, which reduces the compliance, lead to consider mupirocin as first line treatment in primary impetigo. 

Author Biographies

Ravichandran Velappan, Department of Dermatology, Chengalpattu Medical College, Tamil Nadu, India

PROFESSOR, DEPARTMENT OF DERMATO VENEREO LEPROSY

Sindhuja Ramasamy, Department of Dermatology, Chengalpattu Medical College, Tamil Nadu, India

ASSOCIATE PROFESSOR, DEPARTMENT OF DERMATO VENEREO LEPROSY

Shridhar Venu, Department of Dermatology, Chengalpattu Medical College, Tamil Nadu, India

ASSISTANT PROFESSOR, DEPARTMENT OF DERMATO VENEREO LEPROSY

Muthusubramanian Chandrasekar, Department of Dermatology, Chengalpattu Medical College, Tamil Nadu, India

JUNIOR RESIDENT, DEPARTMENT OF DERMATO VENEREO LEPROSY

References

Sladden MJ, Johnston GA, Common skin infections in Children. BMJ. 2004;329(7457):95-9.

Mehta SM, Garg BR, Kanungo R. A clinica bacteriological study of primary uncomplicated bacterial skin infections of children in Pondicherry. Indian J Dermatol Venereol Leprol. 1992;58:183 7.

Mehta TK. Pattern of skin disease in India. Indian J Dermatol Venereol Leprol. 1962;28:134 9.

Pasricha JS, Gupta R. Pyodermas. In: Textbook of Dermatology. Delhi: Jaypee; 1999: 28.

Leyden JJ, Kligman AM. Rationale for topical antibiotics. Cutis. 1978;22:515-28.

Pasricha JS, Gupta R. Pyodermas. In: Textbook of Dermatology. Delhi: Jaypee; 1999: 28.

Koning S, van der Sande R, Verhagen AP, van Suijlekom-Smit LWA, Morris AD, Butler CC, et al. Interventions for impetigo. Cochrane Database Systematic Rev. 2012;1:CD003261.

Jacobs MR, Appelbaum PC. Nadifloxacin: A quinolone for topical treatment of skin infections and potential for systemic use of its active isomer, WCK 771. Expert Opin Pharmacother. 2006;7:1957 66.

Hahn RG, Knox LM, Forman TA. Evaluation of post streptococcal illness. Am Family Physician. 2005;71(10):1949-54.

George A, Rubin G. A systematic review and meta-analysis of treatments for Impetigo. Br J Gen Pract. 2003;53(1491):480-7.

Bork k, Brauers J, Kresken M, Efficacy and safety of 2% mupirocin ointment in the treatment of primary and secondary skin infections-an open multicentre trial. Br J Clin Pract. 1989;43(8):284-8

Parenti MA, Hatfield SM, Leyden JJ. Mupirocin: A Topical antibiotic with unique structure and mechanism of action. Clin Pharm. 1987;6(10)761-70.

Schofer H, Simonsen L. Fusidic acid indermatology; An updated review. Eur J Dermatol. 2010;20(1):6-15.

Gilbert M, Topical 2% Mupirocin versus 2% Fusidic acid ointment in the treatment of primary and secondary skin infection Randomised controlled trial, J Am Acad Dermatol. 1989;20(6):1083-7.

Morley PA, Munot LD, A comparison of sodium fusidate ointment and mupirocin ointment in superficial skin sepsis, Randomised controlled trial, Curr Med Res opin. 1988;11(2):142-8.

White DA, Collins PO, Rowsell RB. Topical antibiotics in the treatment of superficial skin infections in general practise-A comparison of mupirocin with sodium fusidate. Randomised controlled trial. J Infect. 1989;18(3):221-9

Koning S, Van der wooden JC. Treatment for impetigo; Evidence favours topical treatment with Mupirocin and Fusidic acid. BMJ. 2004;329(7468):695.

Reddy JVS, Rao AVM, Madhavulu B, Kudagi BL, Mohan PR. A randomised open label parallel group study comparing the safety, effectiveness and adherence between 2% fusidic acid cream versus 1% retapamulin ointment in children with impetigo. Int J Basic Clin Pharmacol. 2019;8:446-52.

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Published

2019-07-24

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Original Research Articles