Study: Expert Panel Compiles Main Pediatric Impetigo Controversies

A recent study in the Journal of Chemotherapy examined the main controversies pertaining to pediatric impetigo.¹ After a preliminary virtual meeting in July 2020, an Italian panel of multispecialty clinicians (pediatrics, infectious disease, dermatology, pharmacology, and microbiology) identified the main controversies and collected the pros and con arguments on each. The paper aimed to reach a consensus to help improve the management of pediatric impetigo and reduce inappropriate antibiotic use and resistance. 

To find the controversies, a preliminary literature search was conducted using PubMed, MedLine, and Cochrane Library. Only literature published in English was included in the search.

Each controversy was discussed from a multidisciplinary perspective until reaching a consensus during the final meeting held November 2020. In order to reach consensus, total agreement among participants was needed. methicillin-resistant Staphylococcus aureus

The main controversies identified were:

• Impetigo caused by methicillin-resistant Staphylococcus aureus (MRSA) may be treated only with systemic antibiotic therapy. 
• The association between topical and oral antibiotics represents the correct treatment of impetigo.
• Ozenoxacin has a potent antimicrobial activity against staphylococci and streptococci, as well as a rapid bactericidal activity and a low risk of antibiotic resistances.
• The efficacy of topical antibiotics is lower than that of the vast majority of oral antibiotics used for localized impetigo.
• In order to evaluate recovery, bacteriological results of skin swabs are crucial.
• The topical antibiotic treatment presents the disadvantage of limited absorption and the risk of sensitization developing contact dermatitis.
• The topical antibiotic treatment is strongly recommended only for children affected by localized non-bullous impetigo.
• Oral antibiotic treatment presents the disadvantage of major risk of systemic side effects (e.g., gastrointestinal side effects) and antibiotic resistances.
• Topical disinfectants represent the ideal strategy for the treatment of impetigo.
• To read the panels opinions pertaining to these controversies, see the full literature review.

Reference:

1. Galli L, Novelli A, Ruggiero G, Stefani S, Fortina AB. Pediatric impetigo: an expert panel opinion about its main controversies. Journal of Chemotherapy. Published online August 18, 2021:1-7.