Treatment of Impetigo in the Pediatric Population: Consensus and Future Directions
March 2020 | Volume 19 | Issue 3 | Original Article | 281 | Copyright © March 2020
Published online February 10, 2020
Lawrence A. Schachner MD,a Antonio Torrelo MD,b Ayman Grada MD MS,c Giuseppe Micali MD,d Pearl C. Kwong MD PhD FAAD,e Gwenolyn B. Scott MD,f Latanya Benjamin MD FAAP FAAD,g Mercedes E. Gonzalez MD FAAD,h Anneke Andriessen PhD,i Thomas Eberlein MD,j Lawrence F. Eichenfield FAAP FAADk
aDivision of Pediatric Dermatology, The Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery; Department of Pediatrics, Leonard M. Miller School of Medicine, University of Miami, FL bDepartment of Dermatology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain cDepartment of Dermatology, Boston University School of Medicine, Boston, MA dDermatology Clinic, University of Catania, Catania, Italy eAffiliated with Wolfson Children’s Hospital, Jacksonville, FL fDivision of Pediatric Infectious Disease (Pediatrics), University of Miami Miller School of Medicine, Miami, FL gPediatric Dermatology, Florida Atlantic University, Boca Raton, FL hThe Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Leonard M. Miller School of Medicine, University of Miami; Pediatric Dermatology of Miami, Miami, FL iRadboud UMC Nijmegen, Andriessen Consultants, Malden, The Netherlands jWCC Wound Competence Centre, Linz, Austria kDepartments of Dermatology and Pediatrics, University of California, San Diego and Rady Children's Hospital, San Diego, CA
Objective: An expert panel of dermatologists and pediatricians convened in February 2019 to establish evidence-based consensus on the management of impetigo in the pediatric patient population.
Methods: The consensus was created in accordance with the Appraisal of Guidelines, Research and Evaluation (AGREE) II instrument. Prior to the consensus meeting, a systematic literature review was conducted, with the selected literature deemed clinically relevant to the consensus statements. Statements were further refined and assessed systematically following established standards. The consensus process consisted of a modified Delphi approach. The consensus was established through a minimal 75% “agree” rate.
Results: Thirteen consensus statements were developed addressing clinical challenges, existing treatment options and their limita-tions, and new therapeutic alternatives.
Conclusion: Bacterial resistance to antimicrobials commonly used in treating impetigo has been reported. Antimicrobial stewardship is critical to optimize patient outcomes and to prevent the development of resistance. Healthcare providers should be aware of local resistance patterns in impetigo to help guide therapy. The use of newer safe and effective topical antibiotic alternatives as a first-line treatment should be an important step in antimicrobial stewardship.
J Drugs Dermatol. 2020;19(3): doi:10.36849/JDD.2020.4679