eCite Digital Repository

Emerging treatment strategies for impetigo in endemic and nonendemic settings: A systematic review


Gahlawat, G and Tesfaye, W and Bushell, M and Abrha, S and Peterson, GM and Mathew, C and Sinnollareddy, M and McMillan, F and Samarawickrema, I and Calma, T and Chang, AY and Engelman, D and Steer, A and Thomas, J, Emerging treatment strategies for impetigo in endemic and nonendemic settings: A systematic review, Clinical Therapeutics, 43, (6) pp. 986-1006. ISSN 0149-2918 (2021) [Refereed Article]


Copyright Statement

Copyright 2021 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (

DOI: doi:10.1016/j.clinthera.2021.04.013


Purpose: Impetigo affects approximately 162 million children worldwide at any given time. Lack of consensus on the most effective treatment strategy for impetigo and increasing antibiotic resistance continue to drive research into newer and alternative treatment options. We conducted a systematic review to assess the effectiveness of new treatments for impetigo in endemic and nonendemic settings.

Methods: We searched PubMed, MEDLINE, CINAHL, Web of Science, and Embase via Scopus for studies that explored treatments for bullous, nonbullous, primary, and secondary impetigo published between August 1, 2011, and February 29, 2020. We also searched online trial registries and hand-searched the reference lists of the included studies. We used the revised Cochrane risk of bias (version 2.0) tool for randomized trials and the National Heart, Lung, and Blood Institute for nonrandomized uncontrolled studies to assess the risk of bias.

Findings: We included 10 studies that involved 6651 participants and reported on 9 treatments in the final analysis. Most clinical trials targeted nonbullous impetigo or did not specify this. The risk of bias varied among the studies. In nonendemic settings, ozenoxacin 1% cream appeared to have the strongest evidence base compared with retapamulin and a new minocycline formulation. In endemic settings, oral co-trimoxazole and benzathine benzylpenicillin G injection were equally effective in the treatment of severe impetigo. Mass drug administration intervention emerged as a promising public health strategy to reduce the prevalence of impetigo in endemic settings.

Implications: This review highlights the limited research into new drugs used for the treatment of impetigo in endemic and nonendemic settings. Limited recent evidence supports the use of topical ozenoxacin or retapamulin for impetigo treatment in nonendemic settings, whereas systemic antibiotics and the mass drug administration strategy have evidence for use in endemic settings. Given the troubling increase in resistance to existing treatments, there is a clear need to ensure the judicious use of antibiotics and to develop new treatments and alternative strategies; this is particularly important in endemic settings.

Item Details

Item Type:Refereed Article
Keywords:drug therapy, group A Streptococcus, impetigo, Staphylococcus aureus, systematic review
Research Division:Biomedical and Clinical Sciences
Research Group:Pharmacology and pharmaceutical sciences
Research Field:Clinical pharmacology and therapeutics
Objective Division:Health
Objective Group:Clinical health
Objective Field:Treatment of human diseases and conditions
UTAS Author:Peterson, GM (Professor Gregory Peterson)
ID Code:146610
Year Published:2021
Web of Science® Times Cited:2
Deposited By:Pharmacy
Deposited On:2021-09-16
Last Modified:2021-11-24
Downloads:7 View Download Statistics

Repository Staff Only: item control page