YOU ARE NOW CONNECTED TO THE TOXLINE (1981 FORWARD, NON-ROYALTY) FILE. ==IMPETIGO== 6 AUTHOR Hogan PR TITLE Impetigo: topical or systemic therapy? SOURCE New Ethicals; VOL 31 ISS Jan 1994, P43-44, 47, (REF 3) ABSTRACT IPA COPYRIGHT: ASHP An overview of impetigo therapy including the use of 2% topical mupirocin or oral floxacillin (flucloxacillin) or other oral antibiotics is presented; the debate over topical vs systemic therapy is addressed. 1 AUTHOR Cassels-Brown G TITLE Comparative study of Fucidin ointment and Cicatrin cream in the treatment of impetigo SOURCE Br. J. Clin. Pract.; VOL 35 ISS Apr 1981, P153-155, (REF 13) ABSTRACT IPA COPYRIGHT: ASHP The effects of Fucidin (fusidate sodium; I) Ointment and Cicatrin Cream (II), containing neomycin sulfate, bacitracin zinc, aminoacetic acid (glycine), cysteine and DL-threonine, were compared in the treatment of impetigo in a blind, randomized study involving 110 patients. Results showed that 69% of the patients receiving I were healed in 7 days as compared to only 47% of the patients receiving II. 9 AUTHOR Parenti MA AUTHOR Hatfield SM AUTHOR Leyden JJ TITLE Mupirocin: a topical antibiotic with a unique structure and mechanism of action. SOURCE Clin Pharm; VOL 6, ISS 10, 1987, P761-70 (REF: 46) ABSTRACT The chemistry, mechanism of action, antimicrobial activity, pharmacokinetics, clinical efficacy, adverse effects, dosage, and administration of mupirocin are reviewed. Mupirocin, formerly termed pseudomonic acid A, is a topical antibiotic under investigation for the treatment of impetigo and other superficial primary and secondary skin infections. Mupirocin (Bactroban, Beecham Laboratories) is currently formulated as a 2% ointment in a water-miscible polyethylene glycol base. The drug is a unique antimicrobial agent because of its structure and mechanism of action. Mupirocin apparently exerts its antimicrobial activity by reversibly inhibiting isoleucyl-transfer RNA, thereby inhibiting bacterial protein and RNA synthesis. Mupirocin has excellent in vitro activity against staphylococci and most streptococci but less activity against other gram-positive and gram-negative bacteria. The drug will only be used topically because of its rapid and extensive systemic metabolism. Several controlled clinical trials documented that mupirocin was significantly better than the polyethylene glycol vehicle alone or ampicillin and as effective as cloxacillin, dicloxacillin, or erythromycin in producing clinical and bacteriological cures in patients with impetigo and wound infections caused by gram-positive pathogens. Limited studies suggest that mupirocin may also have a role in eradicating nasal carriage of staphylococci. Reported adverse effects are local and may be related to the polyethylene glycol vehicle base. Mupirocin should be useful for treating patients with impetigo and wound infections caused by Staphylococcus aureus. However, additional controlled, comparative clinical studies are needed to identify the role of mupirocin in treating other primary and secondary skin infections and for eliminating nasal carriage of staphylococci. 10 AUTHOR Ward A AUTHOR Campoli-Richards DM TITLE Mupirocin. A review of its antibacterial activity, pharmacokinetic properties and therapeutic use. SOURCE Drugs; VOL 32, ISS 5, 1986, P425-44 (REF: 86) ABSTRACT Mupirocin (pseudomonic acid A) is a novel topical antibacterial agent which inhibits bacterial protein and RNA synthesis. It has excellent in vitro activity against staphylococci and most streptococci, but has less activity against other Gram-positive and most Gram-negative bacteria. Its rapid systemic metabolism means it will only be used topically which, combined with its novel chemical structure, should make cross-resistance less likely to occur than with other currently available topical antibacterial agents. Mupirocin 2% ointment administered 2 or 3 times daily has shown excellent efficacy in both primary and secondary superficial skin infections, usually with at least 80% of patients being clinically cured or markedly improved, and over 90% eradication of the bacterial pathogen involved. Efficacy in impetigo and, to a somewhat lesser extent, infected wounds has been particularly convincingly demonstrated, while in other secondary skin infections the clinical response seen with mupirocin was often similar to the high success rate of vehicle alone. Limited evidence suggests that mupirocin may be as effective as chlortetracycline, fusidic acid, neomycin and other antibacterial agents, but more controlled, comparative studies are needed. The evidence of efficacy against nasal carriage of Staphylococcus aureus, including methicillin-resistant forms, is encouraging and currently work is being undertaken to improve the acceptability of the vehicle for this use. Side effects are limited to local reactions (in less than 3% of patients) and are no more frequent than observed with the vehicle alone. Thus, mupirocin appears to be a useful addition to the agents available for the treatment of superficial primary skin infections, such as impetigo, although its precise place in therapy remains to be established.