International comparison of guidelines for management of impetigo: a systematic review.

Abstract

BACKGROUND:

Impetigo is a common superficial skin infection that affects people worldwide and is usually treated with antibiotics; therefore, its management has implications for global antibiotic stewardship.

OBJECTIVE:

This systematic review and narrative synthesis compares and contrasts international impetigo management guidelines.

METHODS:

Guidelines for treatment of impetigo that were produced by a national authority; available to primary care physicians; and published since 2008 were included. Following a comprehensive search strategy, data extraction from eligible studies was performed independently in duplicate. Details of antiseptic and antibiotic treatment; methicillin-resistant Staphylococcus aureus treatment; and conservative management and preventative measures were tabulated and analysed descriptively.

RESULTS:

Fifty-one guidelines were included from 42 different countries. All guidelines recommended systemic antibiotics, 78% of these only for widespread lesions or failure of topical antibiotic treatment. The first-line systemic antibiotic treatment was restricted to narrow-spectrum options in 21 (41%) whilst 7 (14%) recommended only broad-spectrum antibiotics first-line. Thirty-four (67%) guidelines included recommendations for topical antibiotic use. Twenty guidelines (39%) did not mention antiseptic treatment for impetigo. Guidelines did not always provide clear indications for different treatment options.

CONCLUSIONS:

Despite potentially equal efficacy to systemic antibiotics, only two-thirds of guidelines include topical antibiotic options. Many fail to include recommendations for non-antibiotic treatments such as antiseptics, preventative measures and conservative management, despite potential for antibiotic-sparing. Provision of clear definitions of disease severity and indications for treatment would enhance the ability of clinicians to adhere to recommendations.

SYSTEMATIC REVIEW REGISTRATION:

PROSPERO CRD42018117770.

• Authors: Leanne M Hall, Hilary J Gorges, Mieke van Driel, Parker Magin, Nick Francis, Clare F Heal
• Journal: Family practice (Fam Pract) Vol. 39 Issue 1 Pg. 150-158 (01 19 2022) ISSN: 1460-2229 [Electronic] England
• PMID: 34184743 (Publication Type: Journal Article, Systematic Review)
• Copyright: © The Author(s) 2021. Published by Oxford University Press. All rights reserved.For permissions, please e-mail: [email protected].

Chemical References

• Anti-Bacterial Agents

Topics

• Anti-Bacterial Agents (therapeutic use)
• Antimicrobial Stewardship
• Humans
• Impetigo (diagnosis, drug therapy)
• Methicillin-Resistant Staphylococcus aureus