The effect of antibacterial soap on impetigo incidence, Karachi, Pakistan. Short-course oral co-trimoxazole versus intramuscular benzathine benzylpenicillin for impetigo in a highly endemic region: an open-label, randomised, controlled, non-inferiority trial Comparison of mupirocin and erythromycin in the treatment of impetigo. The microbiology of impetigo in Indigenous children: associations between Streptococcus pyogenes, Staphylococcus aureus,scabies, and nasal carriage Impetigo. Current etiology and comparison of penicillin, erythromycin, and cephalexin therapies. Mass Drug Administration for Scabies Control in a Population with Endemic Disease. The antibacterial activity of tea in vitro and in vivo (in patients with impetigo contagiosa). Treatment of impetigo and ecthyma. A comparison of sulconazole with miconazole. Topical antibiotics in the treatment of superficial skin infections in general practice--a comparison of mupirocin with sodium fusidate. Topical antibiotic treatment of impetigo with mupirocin. Effect of Antenatal Zinc Supplementation on Impetigo in Infants in Bangladesh Trimethopim-sulfamethoxazole compared with benzathine penicillin for treatment of impetigo in Aboriginal children: a pilot randomised controlled trial. Effect of handwashing on child health: a randomised controlled trial Double-blind study comparing erythromycin and mupirocin for treatment of impetigo in children: implications of a high prevalence of erythromycin-resistant Staphylococcus aureus strains. The childhood health effects of an improved water supply system on a remote Panamanian island. Adverse and beneficial secondary effects of mass treatment with azithromycin to eliminate blindness due to trachoma in Nepal. Safety of the trivalent inactivated influenza vaccine among children: a population-based study. The Treatment of Staphyloccocus Aureus Infected Sore Nipples: A Randomized Comparative Study Comparative efficacy and safety of oral fleroxacin and amoxicillin/clavulanate potassium in skin and soft tissue infections. Further studies on the treatment of streptococcal skin infection. Zinc supplementation during pregnancy and effects on growth and morbidity in low birthweight infants: a randomsied placebo controlled trial Physicians' Reactions to Uncertainty in Patient Care: A New Measure and New Insights General practitioner consultations at residential aged-care facilities.
We conducted a study to determine if soap containing 1.2 % triclocarban would be effective in reducing the incidence of impetigo . We r and omized 162 households in a low-income neighborhood of Karachi , Pakistan , to receive a regular supply of 1.2 % triclocarban-containing soap ( n = 81 ) or an identically appearing placebo ( n = 81 ) ; 79 households in a nearby neighborhood were enrolled as st and ard practice controls . After adjustment for household clustering and covariates , the incidence of impetigo among children living in households receiving triclocarban-containing soap ( 1.10 episodes per 100 person-weeks ) was 23 % lower than in households receiving placebo soap ( P = 0.28 ) and 43 % lower than the st and ard habit and practice controls ( P = 0.02 ) . The routine use of triclocarban-containing soap by children living in a community with a high incidence of impetigo was associated with a reduced incidence of impetigo BACKGROUND Impetigo affects more than 110 million children worldwide at any one time . The major burden of disease is in developing and tropical setting s where topical antibiotics are impractical and lead to rapid emergence of antimicrobial resistance . Few trials of systemic antibiotics are available to guide management of extensive impetigo . As such , we aim ed to compare short-course oral co-trimoxazole with st and ard treatment with intramuscular benzathine benzylpenicillin in children with impetigo in a highly endemic setting . METHODS In this r and omised , controlled , non-inferiority trial , Indigenous Australian children aged 3 months to 13 years with purulent or crusted non-bullous impetigo were r and omly assigned ( 1:1:1 ) to receive benzathine benzylpenicillin ( weight-b and ed injection ) , twice-daily co-trimoxazole for 3 days ( 4 mg/kg plus 20 mg/kg per dose ) , or once-daily co-trimoxazole for 5 days ( 8 mg/kg plus 40 mg/kg per dose ) . At every visit , participants were r and omised in blocks of six and 12 , stratified by disease severity . R and omisation was done by research nurses and codes were in sealed , sequentially numbered , opaque envelopes . Independent review ers masked to treatment allocation compared digital images of sores from days 0 and 7 . The primary outcome was treatment success at day 7 in a modified intention-to-treat analysis . This trial is registered with the Australian New Zeal and Clinical Trials Registry , number ACTRN12609000858291 . FINDINGS Between Nov 26 , 2009 , and Nov 20 , 2012 , 508 patients were r and omly assigned to receive benzathine benzylpenicillin ( n=165 [ 156 analysed ] ) , twice-daily co-trimoxazole for 3 days ( n=175 [ 173 analysed ] ) , or once-daily co-trimoxazole for 5 days ( n=168 [ 161 analysed ] ) . Treatment was successful in 133 ( 85 % ) children who received benzathine benzylpenicillin and 283 ( 85 % ) who received pooled co-trimoxazole ( absolute difference 0·5 % ; 95 % CI -6·2 to 7·3 ) , showing non-inferiority of co-trimoxazole ( 10 % margin ) . Results for twice-daily co-trimoxazole for 3 days and once-daily co-trimoxazole for 5 days were similar . Adverse events occurred in 54 participants , 49 ( 90 % ) of whom received benzathine benzylpenicillin . INTERPRETATION Short-course co-trimoxazole is a non-inferior , alternative treatment to benzathine benzylpenicillin for impetigo ; it is palatable , pain-free , practical , and easily administered . FUNDING Australian National Health and Medical Research Council For the past two decades the accepted treatment of impetigo has been systemic antibiotic therapy , l The recently approved topical antibiotic mupirocin has excellent in vitro activity against Streptococcus pyogenes and Staphylococcus aureus , including multiply resistant strains . Originally called pseudomonic acid A , mupirocin is obtained from submerged fermentation of Pseudomonas fluorescens ; it acts by inhibition of bacterial protein synthesis by inactivation of isoleucyl transfer RNA synthetase . Rapidly inactivated and rapidly excreted when given systemically , mupirocin has been shown to be safe in animal and human trials.2 , 3 Double-blind studies prove mupirocin to be more effective than its polyethylene glycol vehicle for treatment of impetigo.4 , 5 Several nonblind or poorly controlled clinical trials have suggested that mupirocin  's  efficacy is comparable to that of orally administered antibiotics commonly used to treat impetigo , namely , erythromycin , 6 - 1~ ampicillin , 11 and dicloxacillin . 12 We intended to vali date these findings in a double-blind , placebo-controlled study . We further hypothesized that erythromycin would cause more adverse side effects and result in poorer compliance , making mupirocin the preferred medication Background Impetigo is caused by both Streptococcus pyogenes and Staphylococcus aureus ; the relative contributions of each have been reported to fluctuate with time and region . While S. aureus is reportedly on the increase in most industrialised setting s , S. pyogenes is still thought to drive impetigo in endemic , tropical regions . However , few studies have utilised high quality microbiological culture methods to confirm this assumption . We report the prevalence and antimicrobial resistance of impetigo pathogens recovered in a r and omised , controlled trial of impetigo treatment conducted in remote Indigenous communities of northern Australia . Methods Each child had one or two sores , and the anterior nares , swabbed . All swabs were transported in skim milk tryptone glucose glycogen broth and frozen at –70 ° C , until plated on horse blood agar . S. aureus and S. pyogenes were confirmed with latex agglutination . Results From 508 children , we collected 872 swabs of sores and 504 swabs from the anterior nares prior to commencement of antibiotic therapy . S. pyogenes and S. aureus were identified together in 503/872 ( 58 % ) of sores ; with an additional 207/872 ( 24 % ) sores having S. pyogenes and 81/872 ( 9 % ) S. aureus , in isolation . Skin sore swabs taken during episodes with a concurrent diagnosis of scabies were more likely to culture S. pyogenes ( OR 2.2 , 95 % CI 1.1 – 4.4 , p = 0.03 ) . Eighteen percent of children  had nasal carriage of skin pathogens . There was no association between the presence of S. aureus in the nose and skin . Methicillin-resistance was detected in 15 % of children who cultured S. aureus from either a sore or their nose . There was no association found between the severity of impetigo and the detection of a skin pathogen . Conclusions S. pyogenes remains the principal pathogen in tropical impetigo ; the relatively high contribution of S. aureus as a co-pathogen has also been confirmed . Children with scabies were more likely to have S. pyogenes detected . While clearance of S. pyogenes is the key determinant of treatment efficacy , co-infection with S. aureus warrants consideration of treatment options that are effective against both pathogens where impetigo is severe and prevalent . Trial registration This trial is registered ; ACTRN12609000858291 We attempted to determine the causative bacterial pathogens of impetigo in children in our area , to compare the effectiveness of three frequently used oral antimicrobial treatment regimens , and to correlate the antimicrobial sensitivity of the bacterial isolates with clinical responses to treatment . Seventy-three children with impetigo were r and omly assigned to receive penicillin V potassium or cephalexin monohydrate , both administered in dosages of 40 to 50 mg/kg per day , or erythromycin estolate administered in a dosage of 30 to 40 mg/kg per day . All drugs were given in three divided doses for 10 days . Treatment failure was defined as persistence of lesions 8 to 10 days after initiation of drug therapy as determined by examiners blinded to the treatment therapies . Forty-five ( 62 % ) cultures showed Staphylococcus aureus only , 14 ( 19 % ) showed S aureus and group A beta-hemolytic streptococci , six ( 8 % ) showed group A beta-hemolytic streptococci only , and eight ( 11 % ) showed no growth or other organisms . Treatment failure occurred in six ( 24 % ) of 25 patients treated with penicillin V , one ( 4 % ) of 25 patients treated with erythromycin estolate , and no patients treated with cephalexin . We conclude that S aureus is the most common cause of impetigo in children in our study population , that cephalexin is the most effective treatment , that erythromycin estolate is nearly equally effective and may be preferred on a cost-effectiveness basis , and that penicillin V is inadequate for treatment of this infection BACKGROUND Scabies is an underrecognized cause of illness in many developing countries . It is associated with impetigo , which can lead to serious systemic complications . We conducted a trial of mass drug administration for scabies control in Fiji . METHODS We r and omly assigned three isl and communities to one of three different interventions for scabies control : st and ard care involving the administration of permethrin to affected persons and their contacts ( st and ard-care group ) , mass administration of permethrin ( permethrin group ) , or mass administration of ivermectin ( ivermectin group ) . The primary outcome was the change in the prevalence of scabies and of impetigo from baseline to 12 months . RESULTS A total of 2051 participants were enrolled ; 803 were in the st and ard-care group , 532 in the permethrin group , and 716 in the ivermectin group . From baseline to 12 months , the prevalence of scabies declined significantly in all groups , with the greatest reduction seen in the ivermectin group . The prevalence declined from 36.6 % to 18.8 % in the st and ard-care group ( relative reduction in prevalence , 49 % ; 95 % confidence interval [ CI ] , 37 to 60 ) , from 41.7 % to 15.8 % in the permethrin group ( relative reduction , 62 % ; 95 % CI , 49 to 75 ) , and from 32.1 % to 1.9 % in the ivermectin group ( relative reduction , 94 % ; 95 % CI , 83 to 100 ) . The prevalence of impetigo also declined in all groups , with the greatest reduction seen in the ivermectin group . The prevalence declined from 21.4 % to 14.6 % in the st and ard-care group ( relative reduction , 32 % ; 95 % CI , 14 to 50 ) , from 24.6 % to 11.4 % in the permethrin group ( relative reduction , 54 % ; 95 % CI , 35 to 73 ) , and from 24.6 % to 8.0 % in the ivermectin group ( relative reduction , 67 % ; 95 % CI , 52 to 83 ) . Adverse events were mild and were reported more frequently in the ivermectin group than in the permethrin group ( 15.6 % vs. 6.8 % ) . CONCLUSIONS Mass drug administration , particularly the administration of ivermectin , was efficacious for the control of scabies and impetigo . ( Funded by the Australian National Health and Medical Research Council ; Australian New Zeal and Clinical Trials Registry number , ACTRN12613000474752 . ) A total number of 104 patients with impetigo contagiosa was included in this study . They were 47 females ( 45.2 % ) and 57 males ( 54.8 % ) . Their ages ranged from one month to 40 years with a median of 4 years . This study was divided into two parts : PART I ( in vitro ) : Thirty-five patients were swabbed to determine the microbiology of impetigo contagiosa which included 33 isolates of pure S. aureus ( 94.3 % ) and 2 of a combination of S. aureus and Streptococcus pyogenes ( 5.7 % ) . The antibacterial effect of tea liquor ( lotion ) against S. aureus proved very effective . Antibiotic sensitivity was done for all bacterial isolates of S. aureus . PART II ( in vivo ) : The antibacterial effects of tea liquor and ointment were tested by treating 64 patients with impetigo contagiosa . Tea ointment was very effective with a cure rate of 81.3 % . Forty patients were taken as controls and divided into two groups . The first one was given an ointment containing Framycetin and gramicidin ( soframycin ) with a cure rate of 72.2 % ; the other group was given oral cephalexin with a cure rate of 78.6 % . To the best of our knowledge , this study was the first one which demonstrated the anti-bacterial action of crude tea in vivo , against impetigo contagiosa . Clinical data about impetigo are also included in this study In a r and omized , double-blind , parallel comparative study of 80 patients , impetigo and ecthyma were treated effectively by sulconazole nitrate 1 % cream and miconazole nitrate 2 % cream applied to lesions twice daily for 14 days . When treatment began , bacterial cultures from all pyodermal lesions yielded Group A beta-hemolytic streptococci or pathogenic staphylococci . Among the 32 sulconazole-treated impetigo patients , bacterial cultures from 26 ( 69 % ) were negative by treatment day 4 , and those from all 32 ( 100 % ) were negative by treatment day 7 ; among the 34 miconazole-treated impetigo patients , cultures from 17 ( 50 % ) were negative by treatment day 4 , cultures from 32 ( 94.1 % ) were negative by treatment day 7 , and cultures from 29 ( 97 % ) were negative by treatment day 14 . Each treatment promptly relieved the pyodermal signs ( crusts , vesicles , pustules , bullae , and exu date ) . Both agents were considered to be safe and effective medications for treating impetigo and ecthyma A total of 413 eligible patients took part in an observer-blind r and omised multicentre clinical trial in order to compare the clinical and bacteriological efficacy of mupirocin ( Bactroban ) ointment with sodium fusi date ( Fucidin ) ointment for treating  superficial skin infections seen in general practice .  Mupirocin was applied twice daily and sodium fusi date thrice daily for a period of 7 days . Both treatments were similarly effective with 97 % patients treated with mupirocin and 93 % patients treated with sodium fusi date responding . Mupirocin was significantly more effective in the treatment of acute primary skin infections and in the treatment of a subgroup of patients with impetigo ( P less than 0.01 ) . Of the organisms detected before treatment began , 93 % were not found after treatment with mupirocin compared with 89 % after treatment with sodium fusi date .  Staphylococcus aureus and /or beta-haemolytic streptococci appeared to be eliminated in significantly more patients treated with mupirocin ( 96 % ) compared with those treated with sodium fusi date ( 88 % ) , ( P = 0.03 ) . Both treatments were well tolerated Because the effectiveness of topical antimicrobials in the treatment of ecthyma , impetigo , and pyoderma is not well established , the US Food and Drug Administration has recently proposed guidelines for tests of topical antimicrobial efficacy in primary skin infections . The guidelines require both comparison with the agent 's base and microbiologic documentation of efficacy . These guidelines were followed in this double-blind , eight-day evaluation of impetigo/ecthyma treated with mupirocin , a new agent that is only active topically . All cultures , before and after therapy , were taken using swabs dipped in neutralizing broth plus 10 % fetal bovine serum to minimize antimicrobial " carry over " to the culture plate . Staphylococcus aureus , which was isolated from 94 % of the patients before therapy , was eliminated in 88 % of the mupirocin-treated patients and 47 % of the vehicle-treated patients . Group A beta-hemolytic streptococci were eliminated in 100 % of the mupirocin-treated and 0 % of the vehicle-treated patients . To our knowledge , this is the first topical antibacterial treatment for  primary skin infections proved superior to its vehicle using the proposed US Food and Drug Administration guidelines We sought to determine the effects of maternal zinc supplementation on  skin infections among infants in poor urban areas of Dhaka , Bangladesh . A double-blind , placebo-controlled , r and omized trial was conducted among 199 and 221 Bangladeshi infants whose mothers were administered 30 mg daily of zinc or placebo , respectively . The mothers received zinc supplementation from 12–16 weeks ’ gestation until delivery , and the infants were followed up until 6 months of age . Among the infants of mothers who received zinc supplementation during the antenatal period , 10.6 % had at least 1 episode of impetigo compared with 19.6 % of the infants of mothers in the placebo group ( P = 0.01 ) . Infants in the treatment group had a 54 % reduction in incidence rate of episodes of impetigo when compared with infants in the placebo group ( P = 0.01 ) . The effect of zinc supplementation was more pronounced among male infants ( 64 % reduction ) and intrauterine growth restricted and low birth weight infants ( 73 % reduction ) and among infants of mothers with increased parity ( 60 % reduction ) or decreased socioeconomic status ( 71 % reduction ) We conducted a pilot r and omized controlled trial comparing trimethoprim-sulfamethoxazole to benzathine penicillin for treatment of impetigo in Aboriginal children . Treatment was successful in 7 of 7 children treated with trimethoprim-sulfamethoxazole and 5 of 6 treated with benzathine penicillin . Trimethoprim-sulfamethoxazole achieved microbiological clearance and healing of sores from which beta-hemolytic streptococci and community-associated methicillin-resistant Staphylococcus aureus were initially cultured BACKGROUND More than 3.5 million children aged less than 5 years die from diarrhoea and acute lower respiratory-tract infection every year . We undertook a r and omised controlled trial to assess the effect of h and washing promotion with soap on the incidence of  acute respiratory infection , impetigo , and diarrhoea .  METHODS In adjoining squatter settlements in Karachi , Pakistan , we r and omly assigned 25 neighbourhoods to h and washing promotion ; 11 neighbourhoods ( 306 households ) were r and omised as controls . In neighbourhoods with h and washing promotion , 300 households each were assigned to antibacterial soap containing 1.2 % triclocarban and to plain soap . Fieldworkers visited households weekly for 1 year to encourage h and washing by residents in soap households and to record symptoms in all households . Primary study outcomes were diarrhoea , impetigo , and acute respiratory-tract infections ( ie , the number of new episodes of illness per person-weeks at risk ) . Pneumonia was defined according to the WHO clinical case definition . Analysis was by intention to treat . FINDINGS Children younger than 5 years in households that received plain soap and h and washing promotion had a 50 % lower incidence of pneumonia than controls ( 95 % CI ( -65 % to -34 % ) . Also compared with controls , children younger than 15 years in households with plain soap had a 53 % lower incidence of diarrhoea ( -65 % to -41 % ) and a 34 % lower incidence of impetigo ( -52 % to -16 % ) . Incidence of disease did not differ significantly between households given plain soap compared with those given antibacterial soap . INTERPRETATION H and washing with soap prevents the two clinical syndromes that cause the largest number of childhood deaths globally-namely , diarrhoea and acute lower respiratory infections .  H and washing with daily bathing also prevents impetigo Staphylococcus aureus has been consistently isolated from a high proportion of impetiginous lesions , and in several recent studies , it was present in the majority of the cases . Since recently a large proportion of S. aureus strains in our community showed erythromycin resistance , we undertook a prospect i ve double-blind controlled study comparing topical mupirocin with oral erythromycin to determine ( i ) the prevalence of erythromycin-resistant S. aureus strains in impetigo and ( ii ) whether an increased rate of failure of erythromycin treatment was associated with such resistance . A total of 102 patients 3 to 185 months old ( median = 49 months ) were enrolled .  Culture was positive for 97 of 102 ( 95 % ) patients , and S. aureus was present in 93 % of the patients for whom cultures were positive . S. aureus was the single pathogen in 64 % of these patients . Erythromycin-resistant S. aureus strains were present in 27 of 91 ( 28 % ) patients for whom cultures were positive . In all cases but one , S. aureus was resistant to penicillin , and in all cases it was sensitive to mupirocin . A marked difference was observed in favor of mupirocin in the clinical courses of the disease . However , only patients with erythromycin-resistant S. aureus strains had unfavorable courses compared with those treated with mupirocin ( failure rate , 47 versus 2 % , respectively ) . Patients with erythromycin-susceptible S. aureus strains who received erythromycin had a failure rate of 8 % . In four patients , S. aureus strains initially susceptible to erythromycin became resistant during treatment . We conclude that erythromycin-resistant S. aureus strains are commonly isolated from impetigo in our region . ( ABSTRACT TRUNCATED AT 250 WORDS The incidence of  diarrhea , respiratory disease , and skin infections  was prospect ively determined after the introduction of a system which distributed unlimited quantities of high quality fresh water to each of the 150 housing units on Tupile , an isl and devoid of fresh water located off Panama 's Caribbean coast and inhabited by 1,500 Cuna Indians . Tupile residents used 7.1 liters of water/person/day compared to the 2.3 usage rate of inhabitants on Achutupo , the control isl and . Despite ready availability of water in each household , Tupile residents continued to store water in contaminated vessels prior to use . Forty percent of stored water sample s tested on Tupile and 45 % on Achutupo were contaminated with E. coli organisms . There were 4.7 episodes/child year ( E/Y ) of acute diarrhea on Tupile compared with the 3.5 rate on Achutupo . The rotavirus infection rate on Tupile was 0.8 E/Y compared with 0.2 E/Y on Achutupo . Infection rates for Norwalk virus , respiratory syncytial virus and Coxsackie B 1 - 6 viruses were similar on both isl and s. Respiratory disease rates were high on both isl and s ( 2.2 E/Y on Tupile , 2.7 E/Y on Achutupo ) . Achutupo had much higher rates of impetigo and scabies ( 0.6 E/Y and 2.5 E/Y , respectively ) than Tupile ( 0.2 E/Y and 1.4 E/Y ) . Provision of the water distribution system had a beneficial effect on the incidence of water-washed diseases ( impetigo and scabies ) , but at best had no effect on diarrheal disease Mass administration of azithromycin to eliminate blindness due to trachoma has raised concerns regarding the emergence of antimicrobial resistance . During 2000 , we compared the antimicrobial resistance of nasopharyngeal pneumococcal isolates recovered from and the prevalence of impetigo , respiratory symptoms , and diarrhea among 458 children in Nepal before and after mass administration of azithromycin .  No azithromycin-resistant  pneumococci were isolated except from 4.3 % of children who had received azithromycin during 2 previous mass treatments ( P<.001 ) . There were decreases in the prevalence of impetigo ( from 14 % to 6 % of subjects ; adjusted odds ratio [ OR ] , 0.41 ; 95 % confidence interval [ CI ] , 0.21 - 0.80 ) and diarrhea ( from 32 % to 11 % ; adjusted OR , 0.26 ; 95 % CI , 0.14 - 0.43 ) 10 days after azithromycin treatment . The absence of macrolide-resistant isolates after 1 mass treatment with azithromycin is encouraging , although the recovery of azithromycin-resistant isolates after 2 mass treatments suggests the need for resistance monitoring when multiple rounds of antimicrobial treatment are given BACKGROUND To our knowledge , there are no published population -based studies on the safety of the inactivated trivalent influenza vaccine among children . OBJECTIVE To screen a large population of children for evidence of increased medical visits in the 2 weeks after  influenza vaccination  compared with 2 control periods . Secondary analyses included shorter risk periods and restricted age categories . DESIGN Self-control screening analysis . Children vaccinated from January 1 , 1993 , through December 31 , 1999 , were r and omly divided into 2 equal groups . In group 1 , risks of outpatient , emergency department , and inpatient visits during the 14 days after vaccination were compared with the risks of visits in 2 control periods . Significant plausible medically attended events identified in group 1 were then analyzed in group 2 , using the same 2 control periods . Medically attended events significant in both groups were considered potentially associated with vaccination and were assessed by medical record review . SETTING Five managed care organizations in the United States . PARTICIPANTS Children younger than 18 years who received an influenza vaccination in one of the managed care setting s ( N = 251 600 ) . MAIN OUTCOME MEASURE Among vaccinated children seen for a medically attended event , the odds of the visit occurring in the 2 weeks after vaccination vs during 1 of the 2 control periods . RESULTS Study participants incurred 1165 , 230 , and 489 different diagnoses during the 14 days after vaccination according to the outpatient , emergency department , and inpatient data , respectively . Four diagnoses were positively associated with the vaccine in both groups 1 and 2 : impetigo , dermatitis , uncomplicated diabetes mellitus , and ureteral disorder not otherwise specified . After medical record review , impetigo ( 9 cases ) in children 6 to 23 months old remained significantly associated with vaccination . CONCLUSION This large screening safety study did not reveal any evidence of important medically attended events associated with pediatric influenza vaccination Sore , cracked nipples are commonly experienced by breastfeeding mothers . We have previously reported a strong correlation between sore , cracked nipples and S. aureus colonization . A prospect i ve , r and omized clinical trial was performed to compare four treatmnent regimes for S. aureus infected sore nipples . Eighty-four breastfeeding mothers were enrolled in the study . After 5 days to 7 days of treatment , only 8 % of mothers showed improvement in the  " optimal breastfeeding technique alone "  group , 16 % improved with topical mupiricin , 29 % improved with topical fusidic acid , yet 79 % improved with oral antibiotics ( p<.0001 ) . Optimal breastfeeding techniques  and topical antibiotics ointment  failed to heal most infected , sore , cracked nipples . Mastitis developed in 12 % to 35 % of mothers not treated with systemic antibiotics compared to 5 % of mothers treated with systemic antibiotics ( p<.005 ) . In conclusion , S. aureus infected sore , cracked nipples should be diagnosed as a potentially widespread impetigo vulgaris and treated aggressively with systemic antibiotics in order to improve healing and decrease the risk of developing mastitis due to an ascending lactiferous duct bacterial infection The objective of this open-label , r and omized , multicenter study was to compare the efficacy and safety of fleroxacin , 400 mg administered orally once daily , and amoxicillin/clavulanate potassium ( AMX/CP ) , 500 mg/125 mg administered orally three times daily , for 4 - 21 days to patients with skin and soft tissue infections ( SSTIs ) . The specific diagnoses in both groups were primarily skin abscess , impetigo , and skin ulcer , as well as wound infection erysipelas , folliculitis , cellulitis , and lymphangitis . A total of 285 patients were r and omized to treatment in a 2:1 ratio , 190 in the fleroxacin group and 95 in the AMX/CP group . Adult male or female in patients or out patients were included in the trial and were followed up after 3 - 5 days of therapy and 3 - 9 days after completion of therapy for assessment of bacteriologic , clinical , and safety parameters . The most frequently isolated pathogen in both treatment groups was Staphylococcus aureus . Bacteriologic cures were observed in 87 ( 76 % ) of 115 evaluable patients in the fleroxacin group and in 41 ( 72 % ) of 57 evaluable patients in the AMX/CP group . Clinical cure was seen in 86 ( 75 % ) of 114 patients in the fleroxacin group and 45 ( 79 % ) of 57 patients in the AMX/CP group . Clinical adverse events related to the trial medication were reported by 40 ( 21 % ) of 189 patients in the fleroxacin group and by 16 ( 17 % ) of 95 patients in the AMX/CP group . In both groups , most adverse events were mild or moderate in severity and involved the digestive system ( primarily diarrhea , nausea , and vomiting ) . In the fleroxacin group , adverse events affecting the central nervous system ( mainly dizziness , insomnia , somnolence ) also were reported . In this study , both fleroxacin and amoxicillin/clavulanate potassium were effective and well tolerated in the treatment of skin and soft tissue infections Erythromycin , phenoxymethyl penicillin , and intramuscularly administered benzathine penicillin G were compared in the treatment of 708 patients with bacteriologically proved streptococcal skin infection . All forms of therapy were highly effective in eradicating skin streptococci . However , benzathine penicillin G proved more effective than the oral preparations in preventing early recurrences or new cases of impetigo and in reducing streptococcal respiratory carrier rates . Acute nephritis developed in 5 of 91 children known to be infected with nephritogenic streptococci BACKGROUND Infant malnutrition and mortality rates are high in less-developed countries especially in low-birthweight infants . Zinc deficiency is also widely prevalent in these circumstances . We aim ed to assess the effect of daily zinc supplements given to pregnant mothers on their infants ' growth and morbidity . METHODS We did a double-blind , placebo controlled , r and omised trial in 199 and 221 Bangladeshi infants whose mothers took 30 mg daily elemental zinc or placebo , respectively , from 12 to 16 weeks ' gestation until delivery . Infants were followed up until 6 months of age . We obtained data for morbidity every week by mothers ' recall . Infants ' anthropometric measurements were done every month , and their serum zinc was assessed at 1 and 6 months of age . FINDINGS Infants of mothers who received zinc during pregnancy had at age 6 months reduced risks compared with those in the placebo group for acute diarrhoea ( risk ratio 0.84 ; 95 % CI 0.72 - 0.98 ) , dysentery ( 0.36 ; 0.25 - 0.84 ) , and impetigo ( 0.53 ; 0.34 - 0.82 ) . These reductions were seen in low-birthweight infants but not in those with normal birthweight . There were no differences in infant growth or serum zinc concentrations between treatment groups . INTERPRETATION Maternal zinc supplementation during pregnancy result ed in a reduction of the health risks in Bangladeshi low-birthweight infants , although this intervention did not improve birthweight . Whether zinc should be added to usual antenatal supplements in regions with high rates of low birthweight should be review ed Although variations in physicians ' practice patterns and use of re sources are well documented , the reasons for these variations are less well understood . The uncertainty inherent in patient care may be one explanation . Existing measures of intolerance to uncertainty , developed in context s outside of patient care , fail to explain these variations . To address this limitation , the Physicians ' Reactions to Uncertainty scale was developed . A question naire containing an initial pool of 61 items was mailed to a r and om sample of 700 physicians in North Carolina and Oregon , stratified by specialty . The items covered nine areas of physicians ' reactions to uncertainty derived from interviews with physicians and a definition of the concept affective reactions to uncertainty in patient care . Factor analysis of the 428 responses received yielded two primary factors that accounted for 58 % of the common variance among the 61 items . Items with unambiguous loadings on these factors defined two reliable and readily interpretable subscales : Stress from Uncertainty ( Cronbach 's alpha = 0.90 , 13 items ) and Reluctance to Disclose Uncertainty to Others ( alpha = 0.75 , 9 items ) . By virtue of its clarity and good psychometric properties , this new measure promises insights into the role that uncertainty plays in physicians ' re source utilization and practice patterns OBJECTIVES To describe the patients seen and the clinical activity undertaken by general practitioners during encounters at residential aged-care facilities ( RACFs ) , and to ascertain how these differ from all GP encounters in Australia as a whole . DESIGN AND PARTICIPANTS A secondary analysis of encounter data from the Bettering the Evaluation and Care of Health ( BEACH ) study , April 2004 to March 2006 , comparing RACF consultations ( identified by Medicare item numbers ) with  all BEACH study encounters in Australia . Participants were a r and om sample of GPs who had cl aim ed at least 375 general practice Medicare items in the 3 months prior to the study . MAIN OUTCOME MEASURES Differences in the characteristics of GPs and patients at RACF consultations , morbidities managed , and treatments provided to patients . RESULTS Over the study period there were 2310 RACF encounters out of a total of 197 000 BEACH encounters ; 360/1970 GPs ( 18.4 % ) recorded at least one RACF consultation . GPs aged > or = 45 years were more likely to record at least one RACF consultation than those aged < 45 years . Patients were predominantly women ( 70.7 % ) , and 83.4 % were aged > or = 75 years . At RACF consultations , problems managed significantly more often included chronic problems , as well as psychological , neurological , urological , circulatory , eye and musculoskeletal problems . Dementia was the most common problem managed , at 33 times the usual management rate in everyday practice . Significantly fewer medications , non-pharmacological treatments , referrals , pathology and imaging tests were recorded at RACF consultations . CONCLUSION GP encounters at RACFs involve the management of chronic and complex conditions , including some not frequently seen in everyday general practice . The provision of additional education and re sources where required may assist with workforce shortages in this setting
This review found limited high- quality evidence to inform the treatment of impetigo .
BACKGROUND Impetigo is a common clinical problem seen in general practice .
Uncertainty exists as to the most effective treatment , or indeed if treatment is necessary .
AIM To determine the most effective treatment for impetigo in a systemically well patient .