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Topical Antibiotics for Impetigo: A Review of the Clinical Effectiveness and Guidelines

Last updated: February 21, 2017
Project Number: RC0851-000
Product Line: Rapid Response
Research Type: Drug
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. What is the clinical effectiveness of topical antibiotics for patients with impetigo?
  2. What are the evidence-based guidelines regarding the use of topical antibiotics for the treatment of impetigo?

Key Message

The evidence identified in this report supports the clinical efficacy of topical antibiotics, specifically mupirocin and fusidic acid, for the treatment of impetigo. Insufficient evidence was identified to support the clinical efficacy of bacitracin and a lack of evidence was identified on other topical antibiotics of interest. Evidence from randomized controlled trials of comparative clinical efficacy was lacking or did not support the superiority of mupirocin, fusidic acid, or bacitracin as compared to each other or to other topical antibiotics for the treatment of impetigo. The evidence identified in this report on systemic antibiotic treatment of impetigo supports mupirocin as superior to erythromycin however the evidence also suggests existing local antimicrobial resistance patterns may strongly influence this comparative efficacy. Insufficient evidence was identified on side-effects of the interventions of interest. No Canadian guidelines were identified, however guidelines from Australia and the United States both contained impetigo treatment recommendations for the use of topical mupirocin and topical fusidic acid consistent with the identified clinical evidence.