Topical Ozenoxacin Cream 1% for Impetigo: A Review

July 2019 | Volume 18 | Issue 7 | Original Article | 655 | Copyright © July 2019

Lawrence Schachner MD FAAD,a Anneke Andriessen PhD,B Neal Bhatia MD,c Ayman Grada MD MS,d Dillon Patele

aDivision of Pediatric Dermatology, Department of Dermatology and Cutaneous Surgery; Department of Pediatrics, Leonard M. Miller School of Medicine, University of Miami, FL 

BRadboud UMC Nijmegen, Andriessen Consultants, Malden, The Netherlands

cDSB Consulting LLC, Del Mar, CA 

DDepartment of Dermatology, Boston University School of Medicine, Boston, MA

EBiochemistry and Cell Biology, UC San Diego, Class of 2017, San Diego, CA

Abstract

Background: Impetigo, a bacterial infection that is highly contagious, involves the superficial skin. Topical treatment for impetigo includes amongst other bacitracin, gentamycin, mupirocin, retapamulin, and more recently, ozenoxacin 1% cream. For more severe conditions systemic antibiotics are prescribed and may be combined with a topical treatment. The current review explored the challenges in treating impetigo in pediatric and adult populations and examined the role of ozenoxacin 1% cream as a safe and effective treatment option.


Methods:
We performed PubMed and Google Scholar searches of the English-language literature (2010-2018) using the terms impetigo, bullous impetigo, non-bullous impetigo, antimicrobial and antibiotic resistance, mupirocin, retapamulin, and ozenoxacin. The selected publications were manually reviewed for additional resources. 


Results:
Although guidelines were updated regularly, the recommended treatments have not changed much since 2014. Emerging antimicrobial resistance is a growing concern in dermatology and pediatrics. Impetigo therapy choices should consider the resistance pattern of S. aureus. Ozenoxacin 1% cream is a prescription medicine for topical treatment of impetigo in adults and children 2 months or older. Ozenoxacin has a low probability of selecting spontaneous resistant mutants in quinolone-susceptible or quinolone-resistant bacterial strains and has shown to be active against MRSA isolates. Ozenoxacin 1% cream has potent bactericidal activity and was shown to be effective and safe for the treatment of impetigo in two well-controlled Phase 3 trials. 


Conclusions:
Resistance patterns in a wide range of pathogens against oral or topical antibiotics and antiseptics used for the treatment of dermatological conditions, such as impetigo have been observed. When making treatment decisions for impetigo MRSA and other antimicrobial resistance has to be taken into account. Ozenoxacin 1% cream offers a potent bactericidal activity and has demonstrated clinical efficacy and safety. Combined with its favorable features, such as a low dosing frequency and a 5 days treatment regimen, ozenoxacin 1% cream is an important option for the treatment of impetigo for pediatric and adult populations. 


J Drugs Dermatol. 2019;18(7):655-661. 

INTRODUCTION

Impetigo is a highly contagious bacterial infection involving the superficial skin, primarily due to S. aureus, less frequently S. pyogenes, or both. It occurs most frequently in children ages two to six year but may affect younger and older children and adults as well. Self-inoculation and small family or communities outbreaks are common. There are more than 3 million cases of impetigo in the United States every year.1 Impetigo may be classified as a primary (direct bacterial invasion of an intact skin) or secondary infection of pre-existing skin disease or traumatized skin (atopic dermatitis, scabies, cuts, abrasions, insect bites, and chickenpox)2,3 Secondary impetigo is sometimes referred to as "impetiginization."

Two clinical forms of impetigo are recognized: (1) nonbullous and (2) bullous. The nonbullous type (also known as impetigo contagiosa) is the most common and accounts for around 70% of cases and in the industrialized world is caused by mainly by S. aureus.2 However, S. pyogenes remains a common cause of nonbullous impetigo in developing nations. Clinically, nonbullous impetigo presents as erythematous pustules or vesicles (red sores) that quickly evolve into superficial erosions with a characteristic "honey-colored" crusts. Lesions usually involve the face, around the nose and mouth, but can be seen on extremities and trunk. The lesions are often smaller than 2 cm, not or minimally painful and without erythema or constitutional symptoms, although regional adenopathy may be present.1,2 More severe forms of impetigo may be associated with pruritus, erythema, crusted erosions, fissures, and odor. Bullous impetigo is less common, usually intertriginous areas, and is caused by strains of S. aureus that produce exfoliative