Article - JDDonline - Journal of Drugs in Dermatology

Ranti S. Bolaji MAS BS,^a Tushar S. Dabade MD,^a Cheryl J. Gustafson MD,^a Scott A. Davis MA,^aDaniel P. Krowcuk MD,^a,b and Steven R. Feldman MD PhD ^a,c,d

Center for Dermatology Research, Departments of ^a Dermatology, ^b Pediatrics,^c Pathology, and ^d Public Health Sciences,ke Forest University School of Medicine, Winston-Salem, NC

Abstract

Background: Impetigo is a highly contagious, superficial skin disease that is frequently seen in children. While data support the use of topical antibiotics for treatment, the medications actually prescribed in practice are not well documented.
Objectives: To determine the prescribing pattern of dermatologists and nondermatologists when treating impetigo and the demographics of the patients treated.
Methods: National Ambulatory Medical Care Survey data on office visits for impetigo were analyzed from 1997 to 2007. Patient demographics and the treatments for impetigo were recorded.
Results: During this 10-year period, dermatologists managed an estimated 274,815 impetigo visits and nondermatologists an estimated 3,722,462 visits. Both dermatologists and nondermatologists most frequently prescribed oral antibiotics to treat impetigo. Topical antibiotics were second most common, and a variety of combination treatments were used.
Conclusions: Oral antibiotics are the most common class of medications used to treat impetigo. There is an opportunity for physicians to take advantage of the equally efficacious topical antibiotics for treating impetigo. A shift towards topical antibiotics would likely decrease morbidity (resulting from adverse effects) associated with use of oral agents.

J Drugs Dermatol. 2012;11(4):489-494.

INTRODUCTION

Impetigo is a common, highly contagious, superficial bacterial infection of the skin. The infection is due to Staphylococcus aureus 70%, of the time, but can also be caused by concurrent Streptococus pyogenes organisms. Two forms of impetigo exist: bullous and nonbullous (crusted) impetigo. In bullous impetigo, patients develop flacid bullae that often rupture resulting in a dried yellowish crust. The bullae result from the elaboration of exfoliative toxin by S. aureus. Nonbullous impetigo presents as erythematous macules or papules that become tiny vesicles that rupture leaving a honey-colored crust. Impetigo affects patients of all ages, genders, and races, but most commonly children less than 10 years of age.^1-3

Impetigo can be treated with topical or oral antibiotics. Topical and oral agents have equal efficacy; however, in severe cases, oral antibiotics may be more effective, although the data are unclear. Topical antibiotics have a lower side effect profile than oral agents .^4,5While the use of topical antibiotics may be desirable in the management of typical impetigo, physician practice in this regard is not well characterized. Better understanding of physicians' approaches to impetigo management will allow a comparison with evidence-based guidelines and identify opportunities to decrease morbidity.

The primary objective of this study is to determine the main treatments being prescribed for impetigo and how they differ between dermatologists and non-dermatologists. Secondary objectives include identifying the demographics of impetigo patients and trends in treatment.

METHODS

After approval from our Institutional Review Board, we used data from the National Ambulatory Medical Care Survey (NAMCS) to assess treatments and demographics of patients at medical visits for impetigo. The NAMCS acquires nationwide outpatient data from United States' non-federally employed physicians. The survey uses a multistage probability sample design, which produces unbiased national estimates, in which the basic sampling unit is the physician-patient visit. During a randomly assigned one-week reporting period, the physician records information