De behandeling van impetigo contagiosa: Een systematisch overzicht

Abstract

Background and aim: Impetigo contagiosa is a common disease in general practice, especially among children. Little is known about the relative merits of the many therapeutic options. Our aim was to review all published studies, to see what drugs have been studied to assess the quality of these studies and the effectiveness of the drugs. Method: We performed a systematic review of randomised clinical trials with respect to treatment of impetigo contagiosa. Medline and the Cochrane Controlled Trials Register were searched for relevant publications. Methodological quality was assessed by applying the Jadad scoring system. Results of trials studying the same drugs were pooled. Mean effect and confidence interval were calculated by using Peto's method. Results: The search resulted in 22 published studies. A broad variety of drugs has been studied for their effectiveness in the treatment of impetigo. Heterogeneity of the studies hinders comparison. Effect measures were often described in vague terms. The effect of only desinfecting has never been assessed. Few placebocontrolled studies were found. Only for mupirocine the effect has been compared to that of placebo, mupirocine turned out to be more effective. Studies comparing the effect of mupirocine and fusidine acid showed no difference. Conclusion: This systematic review reveals that published evidence of therapeutic trials in impetigo is insufficient to guide the choice of general practitioners. Mupirocine, although effective, should not be used in primary care because of resistance considerations and for it's role in treating MRSA carriership. Further studies are necessary into the effectiveness of only desinfecting measures, and of fusidine acid