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Impetigo Responds Well to Topical, Systemic Antibiotics. (Let Lesion Number, Type Direct Treatment).

SANDESTIN, FLA. -- Topical as well as systemic antibiotic treatments are appropriate for impetigo, including bullous impetigo and ecthyma, but there are pluses and minuses associated with each type of treatment, Dr. Mark V. Dahl said at a meeting of the Alabama Dermatology Society.

Systemic therapy offers a more rapid clinical response, more complete cure, reduced incidence of resistance and recurrence, and increased compliance due to the simpler regimen. Systemic treatment reaches all sites of colonization, reducing the chance that the infection will spread, said Dr. Dahl, chairman of the department of dermatology at Mayo Clinic Scottsdale (Ariz.).

A number of systemic antibiotics can be used, including floxacillin, erythromycin, azithromycin, Augmentin, clindamycin, and cephalexin. On the downside, systemic antibiotics can't be stopped quickly if the patient develops an allergic reaction, and they may reduce flora at distant sites.

Topical antibiotics can be stopped quickly if necessary and don't affect distant sites, but they can cause sensitization or emergence of resistant strains of bacteria.

Neomycin is a reasonable topical agent because it rarely leads to sensitization. Mupirocin is another good choice. Topicals generally do not act as quickly as systemics. In one study, the cure rate at 1 week was 95% with systemic erythromycin, and 69% with various topical antibiotics.

Concerns of glomerulonephritis after topical therapy are largely unfounded. Studies show that even with streptococcal ecthyma, the percentage of patients who develop glomerulonephritis is no different in those treated topically than in those treated systemically, Dr. Dahl noted.

A good rule of thumb is use topicals for single, crusted lesions, which are usually caused by streptococci, and use systemics for large or multiple bullous lesions, which are usually caused by staphylococci.

If you make a mistake and start with the wrong type of agent, there is generally no harm done. In most cases, either one will work, but if not, you can try the other option. Thus cultures are unnecessary.

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Comment:Impetigo Responds Well to Topical, Systemic Antibiotics. (Let Lesion Number, Type Direct Treatment).
Author:Worcester, Sharon
Publication:Family Practice News
Article Type:Brief Article
Geographic Code:1USA
Date:Nov 1, 2001
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