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Mupirocin vs terbinafine in impetigo
Ergin Ciftci1, Haluk Guriz, Ahmet Derya Aysev
1Pediatric Clinic of Elmadag State Hospital, Ankara, Turkey. erginciftci@doctor.com
Objective:
Terbinafine is an antifungal drug known to have also antibacterial activity against certain Gram-positive and Gram-negative bacteria. It seems that antibacterial and antifungal activity of terbinafine may have an advantage in the treatment of mixed fungal and bacterial superficial skin infections. Nevertheless, clinical relevance of the antibacterial part of its action has not been investigated efficiently. To compare the efficacy and safety of terbinafine with those of mupirocin, which has already proven antibacterial action, in the treatment of impetigo.
Methods:
Children clinically diagnosed as having impetigo were treated with topical mupirocin or topical terbinafine in a randomized fashion. Patients' lesions were examined clinically on days 0, 4, 7, 10 and bacteriologic cultures were obtained on days 0 and 10.
Results:
A total of 62 patients were included in the study. Forty-eight of these patients were eligible for the efficacy and safety analysis. Twenty-five and 23 patients were treated with mupirocin and terbinafine, respectively. The clinical cure rates were 100% for the mupirocin group and 70% for the terbinafine group (p < 0.05). The bacteriological eradication rate for mupirocin-treated children was 100% and that for terbinafine-treated children was 78% (p < 0.05). Presence of bullous lesions appeared to be a factor for poor clinical outcome in the terbinafine group. Mild local adverse effects were noted in a small percentage of patients in each group.
Conclusion:
Antibacterial activity of terbinafine is not strong enough to be an alternative in the treatment of impertigo. It is advisable that terbinafine could be used in combination with an antibacterial drug for superficial skin infections caused by both fungi and bacteria.
Insights
Terbinafine
Area of Science:
- Dermatology
- Infectious Diseases
- Pharmacology
Background:
- Terbinafine exhibits antifungal and antibacterial properties.
- Its antibacterial efficacy in treating skin infections like impetigo requires further clinical investigation.
- Mupirocin is a well-established topical antibacterial agent.
Purpose of the Study:
- To compare the efficacy and safety of topical terbinafine versus mupirocin in treating impetigo in children.
- To evaluate the clinical and bacteriological outcomes of both treatments.
Main Methods:
- A randomized study involving children diagnosed with impetigo.
- Treatment with either topical mupirocin or topical terbinafine.
- Clinical assessments and bacteriologic cultures were performed at specified intervals.
Main Results:
- Mupirocin achieved 100% clinical cure and 100% bacteriological eradication.
- Terbinafine showed lower clinical cure (70%) and bacteriological eradication (78%) rates.
- Bullous lesions negatively impacted terbinafine's clinical outcome; mild local adverse effects were observed in both groups.
Conclusions:
- Topical terbinafine's antibacterial activity is insufficient as a standalone treatment for impetigo.
- Combination therapy with an antibacterial drug may be beneficial for mixed fungal-bacterial skin infections.