USA, for non-MRSA impetigo cases, dicloxacillin or cephalexin, and for MRSA cases, after culture and sensitivity testing, trimethoprim-sulfamethoxazole is mainly used. In Europe, for non-MRSA cases, amoxicillin-clavulanate, clindamycin, or flucloxacillin may be prescribed, and for those with MRSA, mainly clindamycin or vancomycin are recommended.
Oral antibiotics, for seven days, are recommended in widespread or severe bullous impetigo or when the outbreak of impetigo affects several people.5,10 Oral antibiotics are also applicable if the patient has a fever or extensive lymphadenopathy, in which case hospitalization is indicated.10 In those impetigo cases with no MRSA involvement, dicloxacillin, cephalexin, erythromycin, or amoxicillin-clavulanate can be prescribed, and for MRSA suspected or confirmed cases, clindamycin, TMPSMX, tetracycline, telavancin, or daptomycin is recommended (Table 2).10
If the skin has not cleared after the treatment, underlying conditions should be ruled out, and another culture and sensitivity test should be performed.10 In patients who received oral antibiotics, the type of antibiotic should be adjusted. If the skin has not been cleared or exacerbated after three days, hospitalization is to be considered.
Oral antibiotics, for seven days, are recommended in widespread or severe bullous impetigo or when the outbreak of impetigo affects several people.5,10 Oral antibiotics are also applicable if the patient has a fever or extensive lymphadenopathy, in which case hospitalization is indicated.10 In those impetigo cases with no MRSA involvement, dicloxacillin, cephalexin, erythromycin, or amoxicillin-clavulanate can be prescribed, and for MRSA suspected or confirmed cases, clindamycin, TMPSMX, tetracycline, telavancin, or daptomycin is recommended (Table 2).10
If the skin has not cleared after the treatment, underlying conditions should be ruled out, and another culture and sensitivity test should be performed.10 In patients who received oral antibiotics, the type of antibiotic should be adjusted. If the skin has not been cleared or exacerbated after three days, hospitalization is to be considered.
DISCUSSION
Antimicrobial resistance has become a worldwide concern. In 2015 the WHO launched the Global Action Plan on Antimicrobial resistances (GAP on AMR), specifically the One Health program, to fight antimicrobial resistance at the human, veterinary and environmental levels. It is being implemented by many countries in the world with specific country-based programs.21
The strategic objectives of the GAP are 1. Improve awareness and understanding of infections and bacterial mechanisms of action and resistance; 2. Strengthen knowledge on AMR through surveillance and research; 3. Reduce the incidence of infection (preventive measures); 4. Optimize the use of antimicrobial medicines: antibiotic stewardship programs, and 5. Ensure sustainable investment for R&D and implementation of control measures.21
To comply with the strategic objectives of the GAP21 the panel discussed trends of antibiotic resistance related to impetigo treatment and agreed that when prescribing antibiotics, it is essential to know the local trends in antibiotic resistance. The panel recognized that doctors need education in antibiotic stewardship principles as, for some of them, it is an unknown field. For the newest treatment of impetigo with topical ozenoxacin, the panel insisted on short-term use (5 days, twice a day) for localized cases of impetigo.
Antibiotic Resistance and Choosing a Treatment
Antimicrobial resistance is a major threat to public health in the world, and resistance to mupirocin and fusidic acid is increasing worldwide.11-15,22-30 Resistance rate varies from country to country, center to center, as it is linked to resistant bacteria and mechanisms of resistance. Due to increasing concerns about emerging resistance to commonly used antibiotics for impetigo, treatment decisions should consider resistance patterns of S. aureus.22-28 MRSA has been shown to cause impetigo.11
Retrospective observational data collected from skin culture isolates annually between 2005 and 2011 from the University of Miami Hospital outpatient dermatology clinic showed 387 S. aureus isolates and that MRSA increased by 17.0% during the last three years.28
Updates in 2016 on trends in S. aureus resistance in the USA demonstrated that resistance to clindamycin is up by seventeen percent and that there is a changing susceptibility of S. aureus in a pediatric population with an increase of 40% in resistance of isolates to Oxacillin.31
Resistance to Mupirocin
Topical mupirocin is used widely to treat skin and soft tissue infections and eradicate MRSA's nasal carriage. The increase in resistance to mupirocin is related to the widespread use of
The strategic objectives of the GAP are 1. Improve awareness and understanding of infections and bacterial mechanisms of action and resistance; 2. Strengthen knowledge on AMR through surveillance and research; 3. Reduce the incidence of infection (preventive measures); 4. Optimize the use of antimicrobial medicines: antibiotic stewardship programs, and 5. Ensure sustainable investment for R&D and implementation of control measures.21
To comply with the strategic objectives of the GAP21 the panel discussed trends of antibiotic resistance related to impetigo treatment and agreed that when prescribing antibiotics, it is essential to know the local trends in antibiotic resistance. The panel recognized that doctors need education in antibiotic stewardship principles as, for some of them, it is an unknown field. For the newest treatment of impetigo with topical ozenoxacin, the panel insisted on short-term use (5 days, twice a day) for localized cases of impetigo.
Antibiotic Resistance and Choosing a Treatment
Antimicrobial resistance is a major threat to public health in the world, and resistance to mupirocin and fusidic acid is increasing worldwide.11-15,22-30 Resistance rate varies from country to country, center to center, as it is linked to resistant bacteria and mechanisms of resistance. Due to increasing concerns about emerging resistance to commonly used antibiotics for impetigo, treatment decisions should consider resistance patterns of S. aureus.22-28 MRSA has been shown to cause impetigo.11
Retrospective observational data collected from skin culture isolates annually between 2005 and 2011 from the University of Miami Hospital outpatient dermatology clinic showed 387 S. aureus isolates and that MRSA increased by 17.0% during the last three years.28
Updates in 2016 on trends in S. aureus resistance in the USA demonstrated that resistance to clindamycin is up by seventeen percent and that there is a changing susceptibility of S. aureus in a pediatric population with an increase of 40% in resistance of isolates to Oxacillin.31
Resistance to Mupirocin
Topical mupirocin is used widely to treat skin and soft tissue infections and eradicate MRSA's nasal carriage. The increase in resistance to mupirocin is related to the widespread use of