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 .
Double-blind study comparing erythromycin and mupirocin for treatment of impetigo in children: implications of a high prevalence of erythromycin-resistant Staphylococcus aureus strains.
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
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 .