Topical antibiotics Efficacy

We found one systematic review.5 Versus placebo

Mupirocin has been studied in two placebo-controlled trials, both of which found a better effect with mupirocin.8,9 One other RCT showed that fusidic acid was much more effective than placebo (55% of patients cured versus 13%).1C

Versus each other

Several topical antibiotics have been compared directly. Mupirocin and fusidic acid were compared in three studies,11-13 none of which showed a significant difference in treatment effect. Three other studies compared several other antimicrobial preparations with each other and sometimes combined with a topical steroid. Hydrocortisone/potassium hydroxyquinoline sulphate was significantly better than hydrocortisone/miconazole at 2 weeks.14 Sulconazole was better than miconazole (63% versus 5C% cure) at 14 days of treatment.15 No significant differences were found in a three-armed RCT between fusidic acid cream, tetracycline/ polymyxine ointment and neomycin/bacitracin ointment.16

Versus oral antibiotics

Three RCTs compared topical mupirocin with erythromycin,4,17,18 two of which found a small but not significant difference favouring erythromycin.1718

QUESTIONS

What are the effects of treatments on the clearance of impetiginous lesions after 1 week?

One trial of good quality (n = 102) showed a big difference in favour of mupirocine.4 In a metaanalysis, mupirocin was significantly better than erythromycin.5 In a small RCT (n = 32), cephalexin and mupirocin were both significantly more effective than bacitracin cream.19

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