Efficacy, Safety and Adherence to Treatment of Mupirocin verses Fusidic Acid in Primary Impetigo
Introduction
Impetigo is a superficial bacterial skin infection and highly contagious most commonly affects children. Mupirocin is a bactericidal topical antibiotic with minimal systemic absorption, time tested safety preparation used in acute bacterial skin infections, while topical Fusidic acid cream is a bacteriostatic highly active against Staphylococci, Streptococci and other pathogens known to cause impetigo.
Aim
To compare the efficacy, safety and adherence to treatment of mupirocin with fusidic acid in primary impetigo
Patient Profile
- Patients with diagnosis of primary impetigo
- Age between 2-14 years
- Afebrile
- Impetigo lesions <10
- Skin infection rating score more than or equal to 4
- Pus score more than or equal to 1
Methods
- N= 60 patients
Follow up was done on 4th and 7th day of treatment
Outcomes
- Skin infection rating scale (SIRS) was used to assess the severity of disease at baseline and 4th and 7th day of treatment and day -14 follow up. SIRS evaluates 5 signs and symptoms: pus, crust, erythema, itching and pain on a scale (0-3): 0=absent, 1= mild, 2= moderate, 3= severe
- Clinical success was determined by sufficient resolution of signs and symptoms of infection, as evidenced by the SIRS score of zero each for pus, crust and pain and 0/1 for erythema and itching
- Clinical improvement was determined by a SIRS score of 0 for exudates (pus) which does not meet all the criteria for clinical success. Clinical failure is a SIRS score of ≥1 for pus
Results
- Both groups had similar baseline disease characteristics such as number of lesions, the severity of disease (SIRS), and pus scores
- Efficacy at the end of 7 days of treatment with mupirocin was 83.4%, and with fusidic acid was 80%
*p>0.05
- Number of skin lesions, SIRS, pus score and pain scores were statistically (p>0.05) similar between mupirocin and fusidic acid treatment groups
|
All patients |
2% mupirocin |
2% fusidic acid |
P value |
|
Age |
7 |
8 |
>0.05 |
|
Number of lesions at baseline |
7 |
7 |
>0.05 |
|
Number of lesions at end |
0 |
0 |
>0.05 |
|
SIRS at baseline |
8 |
8 |
>0.05 |
|
SIRS at end |
1 |
1 |
>0.05 |
|
Pus score at baseline |
2 |
2 |
>0.05 |
|
Pus score at end |
0 |
0 |
>0.05 |
|
Pain score at baseline |
2 |
2 |
>0.05 |
|
Pain score at end |
0 |
0 |
>0.05 |
- Both mupirocin ointment and fusidic acid cream were tolerated well
Conclusion
- Mupirocin and fusidic acid demonstrated 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
Reference
Int J Res Dermatol. 2019;5;3:511-516
