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International comparison of guidelines for management of impetigo: a systematic review

International comparison of guidelines for management of impetigo: a systematic review
International comparison of guidelines for management of impetigo: a systematic review

BACKGROUND: Impetigo is a common superficial skin infection that affects people worldwide and is usually treated with antibiotics; therefore, its management has implications for global antibiotic stewardship.

OBJECTIVE: This systematic review and narrative synthesis compares and contrasts international impetigo management guidelines.

METHODS: Guidelines for treatment of impetigo that were produced by a national authority; available to primary care physicians; and published since 2008 were included. Following a comprehensive search strategy, data extraction from eligible studies was performed independently in duplicate. Details of antiseptic and antibiotic treatment; methicillin-resistant Staphylococcus aureus treatment; and conservative management and preventative measures were tabulated and analysed descriptively.

RESULTS: Fifty-one guidelines were included from 42 different countries. All guidelines recommended systemic antibiotics, 78% of these only for widespread lesions or failure of topical antibiotic treatment. The first-line systemic antibiotic treatment was restricted to narrow-spectrum options in 21 (41%) whilst 7 (14%) recommended only broad-spectrum antibiotics first-line. Thirty-four (67%) guidelines included recommendations for topical antibiotic use. Twenty guidelines (39%) did not mention antiseptic treatment for impetigo. Guidelines did not always provide clear indications for different treatment options.

CONCLUSIONS: Despite potentially equal efficacy to systemic antibiotics, only two-thirds of guidelines include topical antibiotic options. Many fail to include recommendations for non-antibiotic treatments such as antiseptics, preventative measures and conservative management, despite potential for antibiotic-sparing. Provision of clear definitions of disease severity and indications for treatment would enhance the ability of clinicians to adhere to recommendations.

SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018117770.

0263-2136
Hall, Leanne M
a9f8c8a3-47d5-4668-8eed-bc9e87cea7b9
Gorges, Hilary J
5ce86b6b-6723-4c77-8484-78dbe4f032fd
van Driel, Mieke
daeac878-0204-4bd3-8b06-5389a10c1ab0
Magin, Parker
3cdf4d46-2303-440c-a2a8-1b464925a17b
Francis, Nick
9b610883-605c-4fee-871d-defaa86ccf8e
Heal, Clare F
79f01228-0978-4d69-a2b1-a2f51e020944
Hall, Leanne M
a9f8c8a3-47d5-4668-8eed-bc9e87cea7b9
Gorges, Hilary J
5ce86b6b-6723-4c77-8484-78dbe4f032fd
van Driel, Mieke
daeac878-0204-4bd3-8b06-5389a10c1ab0
Magin, Parker
3cdf4d46-2303-440c-a2a8-1b464925a17b
Francis, Nick
9b610883-605c-4fee-871d-defaa86ccf8e
Heal, Clare F
79f01228-0978-4d69-a2b1-a2f51e020944

Hall, Leanne M, Gorges, Hilary J, van Driel, Mieke, Magin, Parker, Francis, Nick and Heal, Clare F (2021) International comparison of guidelines for management of impetigo: a systematic review. Family Practice. (doi:10.1093/fampra/cmab066).

Record type: Article

Abstract

BACKGROUND: Impetigo is a common superficial skin infection that affects people worldwide and is usually treated with antibiotics; therefore, its management has implications for global antibiotic stewardship.

OBJECTIVE: This systematic review and narrative synthesis compares and contrasts international impetigo management guidelines.

METHODS: Guidelines for treatment of impetigo that were produced by a national authority; available to primary care physicians; and published since 2008 were included. Following a comprehensive search strategy, data extraction from eligible studies was performed independently in duplicate. Details of antiseptic and antibiotic treatment; methicillin-resistant Staphylococcus aureus treatment; and conservative management and preventative measures were tabulated and analysed descriptively.

RESULTS: Fifty-one guidelines were included from 42 different countries. All guidelines recommended systemic antibiotics, 78% of these only for widespread lesions or failure of topical antibiotic treatment. The first-line systemic antibiotic treatment was restricted to narrow-spectrum options in 21 (41%) whilst 7 (14%) recommended only broad-spectrum antibiotics first-line. Thirty-four (67%) guidelines included recommendations for topical antibiotic use. Twenty guidelines (39%) did not mention antiseptic treatment for impetigo. Guidelines did not always provide clear indications for different treatment options.

CONCLUSIONS: Despite potentially equal efficacy to systemic antibiotics, only two-thirds of guidelines include topical antibiotic options. Many fail to include recommendations for non-antibiotic treatments such as antiseptics, preventative measures and conservative management, despite potential for antibiotic-sparing. Provision of clear definitions of disease severity and indications for treatment would enhance the ability of clinicians to adhere to recommendations.

SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018117770.

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e-pub ahead of print date: 29 June 2021

Identifiers

Local EPrints ID: 450344
URI: http://eprints.soton.ac.uk/id/eprint/450344
ISSN: 0263-2136
PURE UUID: 5f8e5a8d-a31d-4369-bb4f-d4823aa52af7
ORCID for Nick Francis: ORCID iD orcid.org/0000-0001-8939-7312

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Date deposited: 23 Jul 2021 18:13
Last modified: 13 Dec 2021 03:35

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Contributors

Author: Leanne M Hall
Author: Hilary J Gorges
Author: Mieke van Driel
Author: Parker Magin
Author: Nick Francis ORCID iD
Author: Clare F Heal

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