Impetigo: current etiology and comparison of penicillin, erythromycin, and cephalexin therapies

Article Abstract:

Impetigo is a highly infectious skin infection that usually begins on the face and then spreads; it starts as localized redness and progresses to itchy blisters, erosions and crusts. In the past, the most common cause of this infection was streptococcus, but more recently Staphylococcus aureus has become the most frequent cause. A study of pediatric clinic patients with impetigo was undertaken to: determine the causative organism; compare the effectiveness of three commonly used antibiotics; and correlate the organism's sensitivity to the antibiotic with the child's response to antibiotic treatment. The three antibiotics used were penicillin, erythromycin, and cephalexin. There were 73 children randomly assigned to treatment with one of the three antibiotic medications. Cultures of the lesions showed 45 (62 percent) to be positive for Staphylococcus aureus only; 14 cultures (19 percent) showed both S. aureus and beta-hemolytic streptococci group A; six (8 percent) showed just the streptococci, and eight (11 percent) showed no organism or other organisms. Treatment was not successful in 6 of 25 patients (24 percent) treated with penicillin, and in 1 of 25 patients (4 percent) treated with erythromycin. No treatment failures were reported in the cephalexin-treated group. It is concluded that the most common cause of impetigo in children is Staphylococcus aureus, and that cephalexin is the most effective treatment. Erythromycin was almost as effective and may be preferred because it is less expensive than cephalexin. Penicillin was not effective in the treatment of impetigo. (Consumer Summary produced by Reliance Medical Information, Inc.)

Antibiotics, Cephalexin

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Penicillin tolerance and erythromycin resistance of group A beta-hemolytic streptococci in Hawaii and the Philippines

Article Abstract:

Streptococcal pharyngitis (strep throat) has traditionally been treated with penicillin. Recent studies have shown that a specific group of streptococcal bacteria called Group A beta-hemolytic streptococci (GABS) are resistant to penicillin treatments in 11 to 21 percent of patients. Many strains of streptococcal bacteria are also resistant to treatment with the antibiotic erythromycin, the second most common therapy for this infection; this trend has been associated with specific geographic areas. In particular, erythromycin-resistant bacterial strains have been reported with greater frequency in Japan than in the United States. The vulnerability of GABS samples to erythromycin and penicillin was assessed in three different populations. These were a military medical center and civilian population, both in Honolulu, Hawaii, and a military medical center in the Philippines. Because of the closer proximity to Japan, it was anticipated that a higher prevalence of resistance to erythromycin would be found in these populations compared with those in the continental U.S. Using minimum inhibitory concentrations, 305 GABS isolates were tested for tolerance and resistance properties for both penicillin and erythromycin. The results revealed no evidence of resistance to, or tolerance for penicillin. A small percentage (3.6 percent) of isolates was resistant to erythromycin. In general, a higher rate of erythromycin resistance was found in the Hawaiian samples, however, this difference was not statistically significant. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Streptococcal infections, Streptococcus, Philippines, Hawaii

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Comparison of amoxicillin and clavulanic acid (Augmentin) for the treatment of nonbullous impetigo

Article Abstract:

Impetigo, a highly contagious skin infection, has been attributed to a streptococcus organism. However, staphylococcus aureus can be isolated from many impetigo lesions, either by itself or along with streptococcus. This study compared the effectiveness of two drugs in treating nonbullous (blistering) impetigo; one drug (amoxicillin) is known to be effective against only streptococcus and the other (amoxicillin plus clavulanic acid, known as Augmentin) is effective against both staphylococcus and streptococcus. Fifty-one children, aged 6 months to 9 years, were randomly assigned to treatment with either amoxicillin or Augmentin. The cultures indicated staphylococcus aureus in all patients and streptococcus in 14 patients (29 percent). The patients treated with Augmentin improved significantly better than those treated with amoxicillin; after two days marked improvement was noted in 71 percent of the patients treated with Augmentin and only 44 percent of those treated with amoxicillin. After five days, marked improvement was noted in 95 percent of the Augmentin patients compared with 68 percent of those treated with amoxicillin. It is concluded that staphylococcus aureus is a common bacteria in nonbullous impetigo, and it may have an important effect upon the course of the infection. (Consumer Summary produced by Reliance Medical Information, Inc.)

Product/Service Evaluation, Amoxicillin, Augmentin (Medication)

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