BMJ 2002;324:203 ( 26 January )

Primary care

Fusidic acid cream in the treatment of impetigo in general practice: double blind randomised placebo controlled trial

Sander Koning, general practitioner, ^a Lisette W A van Suijlekom-Smit, paediatrician, ^b Jan L Nouwen, infectiologist, ^c Cees M Verduin, medical microbiologist, ^c Roos M D Bernsen, statistician, ^a Arnold P Oranje, dermatologist, ^d Siep Thomas, general practitioner, ^a Johannes C van der Wouden, research coordinator. ^a

^a Department of General Practice, Erasmus University and University Hospital Rotterdam, Room Ff 325, PO Box 1738, 3000 DR Rotterdam, Netherlands, ^b Department of Paediatrics, Erasmus University and University Hospital Rotterdam, ^c Department of Medical Microbiology and Infectious Diseases, Erasmus University and University Hospital Rotterdam, ^d Department of Dermato-venereology, Erasmus University and University Hospital Rotterdam

Correspondence to: J C van der Wouden vanderwouden{at}hag.fgg.eur.nl

Objective: To test the hypothesis that fusidic acid would not increase the treatment effect of disinfecting with povidone-iodine alone in children with impetigo.
Design: Randomised placebo controlled trial.
Setting: General practices in Greater Rotterdam.
Participants: 184 children aged 0-12 years with impetigo.
Main outcome measures: Clinical cure and bacterial cure after one week.
Results: After one week of treatment 55% of the patients in the fusidic acid group were clinically cured compared with 13% in the placebo group (odds ratio 12.6, 95% confidence interval 5.0 to 31.5, number needed to treat 2.3). After two weeks and four weeks the differences in cure rates between the two groups had become smaller. More children in the placebo group were non-compliant (12 v 5) and received extra antibiotic treatment (11 v 3), and more children in the placebo group reported adverse effects (19 v 7). Staphylococcus aureus was found in 96% of the positive cultures; no strains were resistant to fusidic acid.
Conclusions: Fusidic acid is much more effective than placebo (when both are given in combination with povidone-iodine shampoo) in the treatment of impetigo. Because of the low rate of cure and high rate of adverse events in the placebo group, the value of povidone-iodine in impetigo can be questioned.

What is already known on this topic Impetigo is the most common skin infection in children Fusidic acid, which is advocated as topical treatment in several countries, has never been investigated in a placebo controlled study What this study adds In combination with povidone-iodine, treatment with fusidic acid is much more effective than placebo None of the strains of Staphylococcus aureus isolated at baseline showed resistance to fusidic acid The value of treatment with povidone-iodine alone can be questioned

---

© BMJ 2002
CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    StumbleUpon    Technorati    What's this?

Relevant Articles

Fusidic acid cream for impetigo

Erwin M Brown, Richard Wise, Olajumoke Sule, Nick Brown, Derek F J Brown, Nigel Burrows, Vivienne C Weston, Timothy C J Boswell, Roger G Finch, William Perkins, Bethan Stoddart, Timothy Collyns, Miles Denton, Paul Zadik, Nicola Young, Susannah E Owen, John S Cheesbrough, S Koning, L W A van Suijlekom-Smit, J L Nouwen, C M Verduin, R M D Bernsen, A P Oranje, S Thomas, and J C van der Wouden
BMJ 2002 324: 1394. [Extract] [Full Text]

Fusidic acid cream is an effective treatment for impetigo
BMJ 2002 324: 0. [Full Text]

This article has been cited by other articles:

• Lee, K. J, Thompson, S. G (2005). The use of random effects models to allow for clustering in individually randomized trials. Clin Trials 2: 163-173 [Abstract]  
• Lee, K. J, Thompson, S. G (2005). Clustering by health professional in individually randomised trials. BMJ 330: 142-144 [Full text]  
• El-Zimaity, D., Kearns, A. M., Dawson, S. J., Price, S., Harrison, G. A. J. (2004). Survey, characterization and susceptibility to fusidic acid of Staphylococcus aureus in the Carmarthen area. J Antimicrob Chemother 54: 441-446 [Abstract] [Full text]  
• van Weel, C., Rosser, W. W. (2004). Improving Health Care Globally: A Critical Review of the Necessity of Family Medicine Research and Recommendations to Build Research Capacity. Ann Fam Med 2: S5-S16 [Abstract] [Full text]  
• Dobie, D, Gray, J (2004). Fusidic acid resistance in Staphylococcus aureus. Arch. Dis. Child. 89: 74-77 [Abstract] [Full text]  
• Koning, S., van Belkum, A., Snijders, S., van Leeuwen, W., Verbrugh, H., Nouwen, J., Op 't Veld, M., van Suijlekom-Smit, L. W. A., van der Wouden, J. C., Verduin, C. (2003). Severity of Nonbullous Staphylococcus aureus Impetigo in Children Is Associated with Strains Harboring Genetic Markers for Exfoliative Toxin B, Panton-Valentine Leukocidin, and the Multidrug Resistance Plasmid pSK41. J. Clin. Microbiol. 41: 3017-3021 [Abstract] [Full text]  
• (2003). OTHER ARTICLES NOTED (Nov 01 to 18 Oct 02). Evid. Based Nurs. 6: e1-1 [Full text]  
• Tveten, Y., Jenkins, A., Kristiansen, B.-E. (2002). A fusidic acid-resistant clone of Staphylococcus aureus associated with impetigo bullosa is spreading in Norway. J Antimicrob Chemother 50: 873-876 [Abstract] [Full text]  
• Brown, E. M, Wise, R., Sule, O., Brown, N., Brown, D. F J, Burrows, N., Weston, V. C, Boswell, T. C J, Finch, R. G, Perkins, W., Stoddart, B., Collyns, T., Denton, M., Zadik, P., Young, N., Owen, S. E, Cheesbrough, J. S, Koning, S, van Suijlekom-Smit, L W A, Nouwen, J L, Verduin, C M, Bernsen, R M D, Oranje, A P, Thomas, S, van der Wouden, J C (2002). Fusidic acid cream for impetigo. BMJ 324: 1394-1394 [Full text]  
• (2002). Fusidic Acid Accelerates Cure of Impetigo. Journal Watch Dermatology 2002: 6-6 [Full text]  

Rapid Responses:

Read all Rapid Responses

Topical fusidic acid in impetigo

Paul M Zadik, et al.
bmj.com, 30 Jan 2002 [Full text]

Fuscidic acid resistance among Staphylococcus aureus causing impetigo.

John S Cheesbrough, et al.
bmj.com, 13 Feb 2002 [Full text]

Fusidic acid resistance in Staphylococcus aureus

Olajumoke Sule, et al.
bmj.com, 13 Feb 2002 [Full text]

Fusidic acid resistant S. aureus: a significant problem ?

Bethan Stoddart, et al.
bmj.com, 23 Feb 2002 [Full text]

Emergence of fusidic acid resistance limits its use

Vivienne C Weston, et al.
bmj.com, 28 Feb 2002 [Full text]

Re: Topical fusidic acid in impetigo

Sander Koning
bmj.com, 28 Feb 2002 [Full text]

Fucidin resistance: an incomplete picture

Julian D Howell, et al.
bmj.com, 5 Apr 2002 [Full text]

Online poll

Find out more on doc2doc >>