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Emerging Treatment Strategies for Impetigo


With increasing antibiotic resistance to treatment, impetigo research has been driven to find newer alternative options.

An article published in Clinical Therapeutics recently conducted a systematic review to assess the efficacy of new treatments for impetigo in both endemic and nonendemic settings. 

The investigators searched PubMed, MEDLINE, CINAHL, Web of Science, and Embase via Scopus for studies that examined treatments for bullous, nonbullous, primary, and secondary impetigo published between August 1, 2011, and February 29, 2020. Online trial registries and hand-search reference lists of the studies were also looked through. The Cochrane risk of bias tool, version 2.0, for randomized trials and the National Heart, Lung, and Blood Institute for nonrandomized uncontrolled studies were used to assess the risk of bias.

In total, 10 studies were included, of which 6,651 patients were involved and 9 treatments were reported in the final analysis. Nonbullous impetigo was targeted by most clinical trials while most others did not specify the type. Additionally, the risk of bias was different for each study.

In nonendemic settings, it was found that ozenoxacin (Xepi; Biofrontera Inc) 1% cream had the strongest evidence base vs retapamulin and a new minocycline formulation. In endemic settings, the results were different, with oral co-trimoxazole and benzathine benzylpenicillin G injection being equally effective in the treatment of severe impetigo. 

Mass drug administration intervention has emerged as a promising public health strategy to reduce the prevalence of impetigo in endemic settings, the authors surmised.

It was determined that research is limited when it comes to new drug treatments for impetigo in both endemic and nonendemic settings. 

“The limited evidence supports the use of topical ozenoxacin or retapamulin for impetigo treatment in nonendemic settings,” the authors wrote. “Whereas systemic antibiotics and the mass drug administration strategy have evidence for use in endemic settings.”

To help respond to the resistance of current treatments, the need for treatment alternatives to antibiotics is needed, particularly in endemic settings. 


1. Gahlawat G, Tesfaye W, Bushell M, et al. Emerging treatment strategies for impetigo in endemic and nonendemic settings: a systematic review. Clin Ther. 2021;43(6):986-1006. doi:10.1016/j.clinthera.2021.04.013 

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