Treatment of Impetigo and Antimicrobial Resistance

April 2021 | Volume 20 | Issue 4 | Original Article | 366 | Copyright © April 2021

Published online March 10, 2021

Lawrence A. Schachner MD FAAD FAAPa, Charles W. Lynde MD FAADb, Leon H. Kircik MD FAADc, Antonio Torrelo MDd, Daniel Hohl MDe, Pearl Kwong MD PhD FAADf, Vikash Oza MDg, Anneke Andriessen PhDh, Adelaide A. Hebert MD FAAD FAAPi

aDepartment of Dermatology & Cutaneous Surgery, Department of Pediatrics, Leonard M. Miller School of Medicine, University of Miami, FL
bDepartment of Medicine, University of Toronto, Lynde Institut for Dermatology and Lynderm Research, Ontario, Canada
cIchan School of Medicine at Mount Sinai, New York, NY; Indiana University Medical Center, Indianapolis, IN; Physicians Skin Care, PLLC, Louisville, KY; DermResearch, PLLC, Louisville, KY
dDepartment of Dermatology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
eUniversity Hospital Lausanne, Switzerland
Jacksonville, FL
gThe Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY
hRadboud UMC, Nijmegen and Andriessen Consultants, Malden, The Netherlands
iUTHealth McGovern Medical School, Houston, TX

Background: Impetigo is a contagious bacterial infection that affects the superficial skin layers. Increasing worldwide antimicrobial resistance (AMR) to existing topical agents commonly prescribed to treat impetigo is central to treatment failure. The Worldwide Health Organization developed a global action plan on AMR, but omitted information about AMR stewardship programs for topical antibiotics. Objectives: The review aims to provide information to clinicians and stakeholders regarding AMR and antimicrobial stewardship on topical antimicrobial drugs for impetigo treatment.
Methods: The literature searches reviewed the status of AMR to current topical antibiotics in impetigo, current therapeutic behavior, and concordance with antimicrobial stewardship principles. Two international panels convened to discuss the output of the searches, and the results of the panel discussions were used in the development of the manuscript.
Results: The literature search included clinical trials, research studies, clinical guidelines, consensus papers, and reviews (if they provided original data), published between January 2008 and May 2019. The articles were selected based on clinical relevancy of impetigo management, clinical efficacy, and safety of the treatment and antimicrobial resistance. The searches resulted in one-hundred and ninety-eight articles. After applying the eligibility criteria, nineteen articles met inclusion criteria and were considered in the present review.
Conclusions: While published antimicrobial stewardship guidelines have focused on systemic antibiotics, few studies have attempted to evaluate topical antibiotic prescribing practices for impetigo treatment. Many of the topical impetigo treatments currently in use have developed resistance. The appropriate use of topical ozenoxacin can help eradicate impetigo while minimizing AMR.

J Drugs Dermatol. 20(4):366-372. doi:10.36849/JDD.5795


Antimicrobial resistance (AMR) has become one of the most important determinants of outcomes in patients with infections.1 A recent report estimates that by 2050, 10 million people per year will die globally due to AMR.1,2,3 This would make the deaths per year attributed to AMR higher than other major causes of deaths, such as cancer, diabetes, and traffic accidents. The cost of AMR is immense, both economically and personally, for patients' quality of life. The continued rise in AMR would cost up to 100 trillion United States (US) Dollars.1 Global consumption of antibiotics in human medicine rose by nearly 40% between 2000 and 2010.4 Linked to considerable differences in usage rates of antimicrobial drugs between countries, there is significant geographical variation in the patterns of AMR. Despite these variations, as intercontinental travel makes the spread and mutation of infectious diseases a global problem, a comprehensive response to AMR is required to limit the rise in its rates. During two international panel meetings on impetigo treatment, essential questions arose regarding AMR patterns and rates of current topical impetigo treatments and the concordance with antimicrobial stewardship principles.


This article aims to address the topic of AMR to topical impetigo treatment and provide information to clinicians and stakeholders regarding methods of antimicrobial stewardship.