Sarah Primhak (New Zealand)
Starship Hospital Paediatric Infectious DiseasesAuthor Of 1 Presentation
THE RESULTS OF THE TIARA TRIAL- TREATING IMPETIGO WITH ANTISEPTICS, REPLACING ANTIBIOTICS: A RANDOMISED CONTROLLED TRIAL COMPARING TOPICAL TREATMENTS OF IMPETIGO
Abstract
Backgrounds:
Impetigo is a superficial bacterial skin infection with a high incidence in New Zealand (NZ). Prescribing of topical antibiotic fusidic acid (FA) in NZ has induced FA resistance and selection of methicillin resistant S. aureus (MRSA). In response, antiseptics are replacing antibiotics, in both NZ and UK, despite limited evidence. This randomised single-blind non-inferiority trial compares topical FA with antiseptic (hydrogen peroxide) and with cleaning and covering the lesions.
Methods
Children aged 5-13 years, presenting to school health clinics in Auckland with mild-to-moderate impetigo were randomised to receive one of three treatments; FA, hydrogen peroxide or wound care for five days. Primary outcome was based on analysis of photographs taken before and after treatment, by three independent graders, blinded to treatment arm. Bacterial swabs were taken pre- and post-treatment.
Results:
84% (132/157) and 79% (134/169) of impetigo improved after 5 days of treatment with FA and antiseptic respectively. 64% (48/74) of those treated with wound care improved. Including all lesions, non-inferiority of antiseptic was not shown. Stratified-analysis of impetigo limited to a single body region, demonstrated non-inferiority of antiseptic compared to FA. Wound care was not shown to be non-inferior to FA. All treatments were acceptable with no severe adverse reactions. Higher rates of bacteria were seen on lesions following treatment with antiseptic and clean and cover than FA.
Conclusions/Learning Points:
Overall antiseptic is neither inferior or non-inferior to topical antibiotics. However, it is non-inferior where impetigo is limited to a single region of the body. Wound care is inferior to FA. Although antiseptic produced clinical resolution for most, higher rates of bacteria remain following treatment with antiseptic. Questions remain over whether this has clinical impact such as recurrence, subsequent skin-related admission or future risks of post-streptococcal phenomena.
Presenter of 1 Presentation
THE RESULTS OF THE TIARA TRIAL- TREATING IMPETIGO WITH ANTISEPTICS, REPLACING ANTIBIOTICS: A RANDOMISED CONTROLLED TRIAL COMPARING TOPICAL TREATMENTS OF IMPETIGO
Abstract
Backgrounds:
Impetigo is a superficial bacterial skin infection with a high incidence in New Zealand (NZ). Prescribing of topical antibiotic fusidic acid (FA) in NZ has induced FA resistance and selection of methicillin resistant S. aureus (MRSA). In response, antiseptics are replacing antibiotics, in both NZ and UK, despite limited evidence. This randomised single-blind non-inferiority trial compares topical FA with antiseptic (hydrogen peroxide) and with cleaning and covering the lesions.
Methods
Children aged 5-13 years, presenting to school health clinics in Auckland with mild-to-moderate impetigo were randomised to receive one of three treatments; FA, hydrogen peroxide or wound care for five days. Primary outcome was based on analysis of photographs taken before and after treatment, by three independent graders, blinded to treatment arm. Bacterial swabs were taken pre- and post-treatment.
Results:
84% (132/157) and 79% (134/169) of impetigo improved after 5 days of treatment with FA and antiseptic respectively. 64% (48/74) of those treated with wound care improved. Including all lesions, non-inferiority of antiseptic was not shown. Stratified-analysis of impetigo limited to a single body region, demonstrated non-inferiority of antiseptic compared to FA. Wound care was not shown to be non-inferior to FA. All treatments were acceptable with no severe adverse reactions. Higher rates of bacteria were seen on lesions following treatment with antiseptic and clean and cover than FA.
Conclusions/Learning Points:
Overall antiseptic is neither inferior or non-inferior to topical antibiotics. However, it is non-inferior where impetigo is limited to a single region of the body. Wound care is inferior to FA. Although antiseptic produced clinical resolution for most, higher rates of bacteria remain following treatment with antiseptic. Questions remain over whether this has clinical impact such as recurrence, subsequent skin-related admission or future risks of post-streptococcal phenomena.