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Comparison of Amoxicillin and Clavulanic Acid (Augmentin) for the Treatment of Nonbullous Impetigo

Comparison of Amoxicillin and Clavulanic Acid (Augmentin) for the Treatment of Nonbullous Impetigo Abstract • We undertook a prospective double-blind controlled study to compare the efficacy of a drug that usually has no antistaphylococcal activity (amoxicillin tri-hydrate) with the efficacy of the same drug with an addition of a β-lactamase inhibitor (amoxicillin plus clavulanic acid [Augmentin]) in the treatment of nonbullous impetigo. Fifty-one culture-positive patients, aged 6 months to 9 years, were included, 26 in the amoxicillin group and 25 in the Augmentin group. The study groups were clinically and bacteriologically comparable at the start of the study. Staphylococcus aureus was isolated from all patients and β-hemolytic streptococcus from 14(29%). All staphylococci were sensitive to Augmentin but resistant to amoxicillin. Forty-nine patients completed the study. The clinical response was significantly better among the Augmentin recipients (marked improvement in 71% and 95% of patients after 2 and 5 days, respectively; no new lesions during the treatment course) than among the amoxicillin recipients (marked improvement in 44% and 68% of patients after 2 and 5 days, respectively; new lesions appeared in 20% of patients). Recurrence within 3 weeks occurred in 12 (26%) of 49 patients, and no difference was observed between the two groups. We conclude that S aureus is common in nonbullous impetigo, and that at least in some cases it plays an important role in the course of the disease that can be altered by specific therapy. (AJDC. 1989;143:916-918) References 1. Burnett JW. The route of antibiotic administration in superficial impetigo . N Engl J Med . 1963;268:72-75.Crossref 2. Hughes WT, Wan RT. Impetigo contagiosa: etiology, complications and comparison of therapeutic effectiveness of erythromycin and antibiotic ointment . AJDC . 1967;113:449-453. 3. Estery NB, Markowitz M. The treatment of pyoderma in children . JAMA . 1970;212:1667-1670.Crossref 4. Dillon HC Jr. The treatment of streptococcal skin infections . J Pediatr . 1970;76:676-684.Crossref 5. Markowitz M, Bruton HD, Kuttner AG, Cluff LE. The bacteriologic findings, streptococcal immune response and renal complications in children with impetigo . Pediatrics . 1965;35:393-404. 6. Dajani AS, Ferrieri P, Wannamaker LW. Natural history of impetigo, II: etiologic agents and bacterial interactions . J Clin Invest . 1972;51:2863-2871.Crossref 7. Schachner L, Talpin D, Scott GB, Morrison M. A therapeutic update of superficial skin infections . Pediatr Clin North Am . 1983;30:397-404. 8. Lookingbill DP. Impetigo . Pediatr Rev . 1985;7:177-181.Crossref 9. Peter G, Smith AL. Group A streptococcal infections of the skin and pharynx (first of two parts) . N Engl J Med . 1977;297:311-317.Crossref 10. Derrick CW Jr, Dillon HC. Impetigo contagiosa . Am Fam Physician . 1971;4:75-81. 11. Esterly NB, Marrowitz M. The treatment of pyoderma in children . JAMA . 1970;212:1667-1670.Crossref 12. White A, Brooks GF. Furunculosis pyoderma and impetigo . In: Hoeprich PD, ed. Infectious Diseases . 2nd ed. New York, NY: Harper & Row Publishers Inc; 1977:785-793. 13. Feigin RD. Staphylococcal infection . In: Vaugham VC, McKay RJ, Behrman RE, eds. Nelson Textbook of Pediatrics . Philadelphia, Pa: WB Saunders Co; 1987:580-583. 14. Swartz MN. Skin and soft tissue infections . In: Mandell GL, Douglass RG, Bennett JE, eds. Principles and Practice of Infectious Diseases . 2nd ed. New York, NY: John Wiley & Sons Inc; 1985:598-624. 15. Disney FA, Pichichero ME. Treatment of Staphylococcus aureus infections in children in office practice . AJDC . 1983;137:361-364. 16. Bauer AW, Kirby WMM, Sherris JL, Turck M. Antibiotic susceptibility testing by a standardized single disc method . Am J Clin Pathol . 1966;45:493-496. 17. Goldfarb J, Crenshaw D, O'Horo J, Snodgras D, Blumer JL. Return to topical therapy for impetigo . In: Abstracts of the 27th Conference for Antimicrobial Agents and Chemotherapy ; (October 4) -7, 1987; New York, NY; Abstract 102. 18. Goldfarb J, Crenshaw D, O'Horo J, Lemon E, Blumer JL. Randomized clinical trial of topical mupirocin versus oral erythromycin for impetigo . Antimicrob Agents Chemother . 1988;32:1780-1783.Crossref 19. McLinn J. Topical mupirocin versus systemic erythromycin treatment for pyoderma . Pediatr Infect Dis J . 1988;7:785-790.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Diseases of Children American Medical Association

Comparison of Amoxicillin and Clavulanic Acid (Augmentin) for the Treatment of Nonbullous Impetigo

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Publisher
American Medical Association
Copyright
Copyright © 1989 American Medical Association. All Rights Reserved.
ISSN
0002-922X
DOI
10.1001/archpedi.1989.02150200068020
Publisher site
See Article on Publisher Site

Abstract

Abstract • We undertook a prospective double-blind controlled study to compare the efficacy of a drug that usually has no antistaphylococcal activity (amoxicillin tri-hydrate) with the efficacy of the same drug with an addition of a β-lactamase inhibitor (amoxicillin plus clavulanic acid [Augmentin]) in the treatment of nonbullous impetigo. Fifty-one culture-positive patients, aged 6 months to 9 years, were included, 26 in the amoxicillin group and 25 in the Augmentin group. The study groups were clinically and bacteriologically comparable at the start of the study. Staphylococcus aureus was isolated from all patients and β-hemolytic streptococcus from 14(29%). All staphylococci were sensitive to Augmentin but resistant to amoxicillin. Forty-nine patients completed the study. The clinical response was significantly better among the Augmentin recipients (marked improvement in 71% and 95% of patients after 2 and 5 days, respectively; no new lesions during the treatment course) than among the amoxicillin recipients (marked improvement in 44% and 68% of patients after 2 and 5 days, respectively; new lesions appeared in 20% of patients). Recurrence within 3 weeks occurred in 12 (26%) of 49 patients, and no difference was observed between the two groups. We conclude that S aureus is common in nonbullous impetigo, and that at least in some cases it plays an important role in the course of the disease that can be altered by specific therapy. (AJDC. 1989;143:916-918) References 1. Burnett JW. The route of antibiotic administration in superficial impetigo . N Engl J Med . 1963;268:72-75.Crossref 2. Hughes WT, Wan RT. Impetigo contagiosa: etiology, complications and comparison of therapeutic effectiveness of erythromycin and antibiotic ointment . AJDC . 1967;113:449-453. 3. Estery NB, Markowitz M. The treatment of pyoderma in children . JAMA . 1970;212:1667-1670.Crossref 4. Dillon HC Jr. The treatment of streptococcal skin infections . J Pediatr . 1970;76:676-684.Crossref 5. Markowitz M, Bruton HD, Kuttner AG, Cluff LE. The bacteriologic findings, streptococcal immune response and renal complications in children with impetigo . Pediatrics . 1965;35:393-404. 6. Dajani AS, Ferrieri P, Wannamaker LW. Natural history of impetigo, II: etiologic agents and bacterial interactions . J Clin Invest . 1972;51:2863-2871.Crossref 7. Schachner L, Talpin D, Scott GB, Morrison M. A therapeutic update of superficial skin infections . Pediatr Clin North Am . 1983;30:397-404. 8. Lookingbill DP. Impetigo . Pediatr Rev . 1985;7:177-181.Crossref 9. Peter G, Smith AL. Group A streptococcal infections of the skin and pharynx (first of two parts) . N Engl J Med . 1977;297:311-317.Crossref 10. Derrick CW Jr, Dillon HC. Impetigo contagiosa . Am Fam Physician . 1971;4:75-81. 11. Esterly NB, Marrowitz M. The treatment of pyoderma in children . JAMA . 1970;212:1667-1670.Crossref 12. White A, Brooks GF. Furunculosis pyoderma and impetigo . In: Hoeprich PD, ed. Infectious Diseases . 2nd ed. New York, NY: Harper & Row Publishers Inc; 1977:785-793. 13. Feigin RD. Staphylococcal infection . In: Vaugham VC, McKay RJ, Behrman RE, eds. Nelson Textbook of Pediatrics . Philadelphia, Pa: WB Saunders Co; 1987:580-583. 14. Swartz MN. Skin and soft tissue infections . In: Mandell GL, Douglass RG, Bennett JE, eds. Principles and Practice of Infectious Diseases . 2nd ed. New York, NY: John Wiley & Sons Inc; 1985:598-624. 15. Disney FA, Pichichero ME. Treatment of Staphylococcus aureus infections in children in office practice . AJDC . 1983;137:361-364. 16. Bauer AW, Kirby WMM, Sherris JL, Turck M. Antibiotic susceptibility testing by a standardized single disc method . Am J Clin Pathol . 1966;45:493-496. 17. Goldfarb J, Crenshaw D, O'Horo J, Snodgras D, Blumer JL. Return to topical therapy for impetigo . In: Abstracts of the 27th Conference for Antimicrobial Agents and Chemotherapy ; (October 4) -7, 1987; New York, NY; Abstract 102. 18. Goldfarb J, Crenshaw D, O'Horo J, Lemon E, Blumer JL. Randomized clinical trial of topical mupirocin versus oral erythromycin for impetigo . Antimicrob Agents Chemother . 1988;32:1780-1783.Crossref 19. McLinn J. Topical mupirocin versus systemic erythromycin treatment for pyoderma . Pediatr Infect Dis J . 1988;7:785-790.Crossref

Journal

American Journal of Diseases of ChildrenAmerican Medical Association

Published: Aug 1, 1989

References