What is the best treatment for impetigo?
Retapamulin produces greater clinical response than placebo in an RCT
A 2008 randomized, double-blind, multicenter, industry-funded, placebo-controlled trial of 213 patients evaluated the effectiveness of retapamulin to treat uncomplicated impetigo with an outcome of clinical response at 7 days.4 Clinical response was defined as total absence of lesions, drying of treated lesions without crusts or erythema, decrease in the size of the affected area or decrease in the number of lesions. Retapamulin ointment produced a higher rate of clinical response than placebo (absolute risk reduction=33.5%; 95% CI, 20.5-46.5; NNT=3, P<.001).
TABLE
How well do impetigo treatments work?3,4
Comparison | Number of patients | ARR for cure or improvement | NNT | Cost of treatment* |
Topical antibiotics vs placebo | 575 | 41.2% | 2 | |
Retapamulin vs placebo | 213 | 33.5% | 3 | Retapamulin 1% ointment (15 g): $130.12 |
Topical antibiotics vs disinfectant solution | 292 | 11.4% | 9 | |
Mupirocin vs fusidic acid | 440 | NS | NS | Mupirocin ointment 2% (22 g): $42.75 Fusidic acid is not available in the United States |
Mupirocin vs oral erythromycin | 581 | 5.1% | 20 | Erythromycin 100 tabs: $295.01 (250 mg), $314.23 (333 mg), $338.93 (500 mg) Erythromycin ethylsuccinate solution (100 mL): $170.50 (200 mg/5 mL), $218.14 (400 mg/5 mL) |
Mupirocin vs dicloxacillin | 53 | NS | NS | Dicloxacillin 100 tabs (250 mg):$66 |
Mupirocin vs ampicillin | 13 | NS | NS | Ampicillin 100 tabs (500 mg): $39.88 Ampicillin suspension 100 mL: $9.54 (125 mg/5 mL), $14.08 (250 mg/5 mL) |
Bacitracin vs oral erythromycin | 30 | NS | NS | Bacitracin ointment 500 units/g (28.4 g): $3.47 |
Bacitracin vs penicillin | 34 | NS | NS | Penicillin V oral 100 tabs (500 mg): $77.77 Penicillin V suspension 100 mL: $3.84 (125 mg/5 mL), $4.31 (250 mg/5 mL) |
Cephalexin vs bacitracin | 19 | 56.7% | 2 | Cephalexin 100 tabs (500 mg): $526.13 Cephalexin oral suspension 100 mL: $8.93 (125 mg/5 mL), $18.90 |
Erythromycin vs penicillin | 79 | 22.4% | 4 | See above |
Cloxacillin vs penicillin | 166 | 35.9% | 3 | Cloxacillin is not available in the United States |
ARR, absolute risk reduction; NNT, number needed to treat; NS, not significant.
*Cost data obtained from Medi-Span at www.uptodate.com. Accessed December 5, 2013.
