Emerging Treatment Strategies for Impetigo in Endemic and Nonendemic Settings: A Systematic Review

AbstractPurpose 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 alternative options. We conducted a systematic review assess effectiveness new treatments in endemic nonendemic settings. Methods searched PubMed, MEDLINE, CINAHL, Web Science, Embase via Scopus studies that explored bullous, nonbullous, primary, secondary published between August 1, 2011, February 29, 2020. also online trial registries hand-searched reference lists included studies. used revised Cochrane risk bias (version 2.0) tool randomized trials National Heart, Lung, Blood Institute nonrandomized uncontrolled bias. Findings 10 involved 6651 participants reported 9 final analysis. Most clinical targeted nonbullous or did not specify this. The varied among In settings, ozenoxacin 1% cream appeared have strongest evidence base compared with retapamulin minocycline formulation. oral co-trimoxazole benzathine benzylpenicillin G injection were equally severe impetigo. Mass drug administration intervention emerged as promising public health reduce prevalence Implications This highlights limited drugs Limited recent supports use topical whereas systemic antibiotics mass Given troubling increase existing treatments, there is clear need ensure judicious develop strategies; this particularly important PROSPERO identifier: CRD42020173042.