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Introduction
Impetigo is the most common skin infection in children; it is caused mainly by Staphylococcus aureus and sometimes by Streptococcus pyogenes (group A). 1 2 Because of the supposedly benign spontaneous course of impetigo, some authors suggest that an expectant attitude with disinfection but no antibiotic treatment would suffice in mild cases. 3 â[euro]" 5 Antiseptic treatment with chlorhexidine or povidone-iodine is often advocated as a useful adjunct to antibiotic treatment. 3 5
Immediate antibiotic treatment is advised for most cases of impetigo, to achieve a quick cure and prevent spread of the infection to other children. 4 â[euro]" 6 Oral antibiotic treatment has long been the first choice, because of better treatment results and because topical antibiotic treatment is more likely to induce sensitisation and bacterial resistance. 7 In recent years, however, the resistance of staphylococci to oral antibiotics such as erythromycin has increased dramatically. 1 8 â[euro]" 11 At the same time, topical antibiotic treatment with mupirocin has been shown to give results equal to or even better than oral treatment. 1 9 12 13 In general, children comply better with topically administered treatment than with oral treatment, 13 and fewer systemic side effects occur. 8
Fusidic acid is an antibiotic that has been available for a long time and is mainly used topically. 14 It is recommended as the first choice topical antibiotic in the Dutch College of General Practitioners' guidelines on the treatment of impetigo. 3 Some authors discourage the topical use of fusidic acid because of its value in systemic treatment, 5 15 although other authors recommend that mupirocin should be reserved for treatment of nasal carriage of S aureus in specific groups of patients. 3 16 A recent meta-analysis of three randomised trials found the overall clinical effect of fusidic acid cream in patients with impetigo to be equal to that of mupirocin, 17 but the effectiveness of fusidic acid has never been assessed in comparison with placebo. The cost of fusidic acid compares favourably with that of mupirocin.
We compared the effectiveness of fusidic acid cream and placebo cream, both added to a disinfecting treatment with povidone-iodine, in the treatment of impetigo in children. Our hypothesis was that fusidic acid cream would not improve the treatment effect...