Intended for healthcare professionals


Fusidic acid cream for impetigo

BMJ 2002; 324 doi: (Published 08 June 2002) Cite this as: BMJ 2002;324:1394

Fusidic acid should be used with restraint

  1. Erwin M Brown, consultant medical microbiologist. (,
  2. Richard Wise, professor of medical microbiology. (
  1. Frenchay Hospital, Bristol BS16 1LE
  2. City Hospital NHS Trust, Birmingham B18 7QH
  3. Clinical Microbiology and Public Health Laboratory, Addenbrooke's Hospital, Cambridge CB2 2QW
  4. Addenbrooke's Hospital
  5. Nottingham Public Health Laboratory, University Hospital Nottingham, Nottingham NG7 2UH
  6. Department of Infectious Diseases, Nottingham City Hospital, Nottingham NG5 1PB
  7. Department of Dermatology, University Hospital Nottingham, Nottingham NG7 2UH
  8. Leeds General Infirmary, Leeds LS1 9XX
  9. Sheffield Public Health Laboratory, Sheffield S5 7BQ
  10. Berry Lane Medical Centre, Preston PR3 3JJ
  11. Public Health Laboratory, Royal Preston Hospital, Preston PR2 9HG
  12. Department of General Practice
  13. Department of Paediatrics
  14. Department of Medical Microbiology and Infectious Diseases
  15. Department of General Practice
  16. Department of Dermato-venereology
  17. Department of General Practice, Erasmus University and University Hospital Rotterdam, 3000 DR Rotterdam, Netherlands

    EDITOR—Koning et al report the results of a clinical trial that showed the efficacy of topical fusidic acid as treatment of patients with impetigo.1 This agent has been recommended by the Dutch College of General Practitioners as the treatment of choice in patients with this infection. Koning et al observed that none of the pretreatment isolates of Staphylococcus aureus was resistant to fusidic acid and concluded that many years of use of topical fusidic acid has not resulted in appreciable resistance in staphylococci in the general population.

    These findings illustrate one of the problems surrounding antimicrobial resistance—namely, that patterns of resistance in one country cannot be extrapolated to those in another. Specifically, data for resistance rates to fusidic acid among S aureus isolates in the United Kingdom differ markedly from those in the Netherlands. In a survey of 28 centres in the United Kingdom the incidence of resistance to fusidic acid among S aureus isolates from the community (excluding strains of methicillin resistant S aureus, which, by their clonal nature, might distort the data) increased from 8.1% in 1995 to 17.3% in 2001 (figure) (R Wise, unpublished data).2 A similar study carried out in Bristol showed an approximately twofold increase in resistance rates (from 6% to 11.5%) among methicillin susceptible S aureus strains isolated between 1998 and 2001.3

    The figure also shows that between 1995 and 2001 the number of prescriptions of fusidic acid in the United Kingdom (expressed as total units dispensed and accounted for almost entirely by the topical formulation) nearly doubled (data supplied by Leo Pharmaceuticals).

    Annual rates of resistance to fusidic acid among isolates of Staphylococcus aureus, with numbers of prescriptions for fusidic acid

    We cannot explain why the Dutch experience does not mirror our own, although Koning et al have not …

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