Oral amoxicillin vs. oral erythromycin in the treatment of pyoderma in Bamako, Mali: an open randomized trial
Ousmane Faye1, Roderick J Hay, Ismaila Diawara
1Center National d'Appui à la lutte contre la Maladie (CNAM), BP 251, Bamako, Mali.
Background:
Pyoderma (bacterial superficial skin infection) is an extremely common disorder in tropical developing countries. In these settings, Streptococcus pyogenes is considered to be the main etiological agent. Apart from epidemics of poststreptococcal glomerulonephritis where mass treatment with intramuscular benzathine-penicillin is recommended, no recommendation exists for the treatment of pyoderma in this setting. The aim of this study was to evaluate the efficacy of oral amoxicillin in the treatment of pyoderma in Mali, by comparison with oral erythromycin.
Methods:
In Bamako, 132 patients with pyoderma, diagnosed and graded as "severe" on clinical grounds, were randomly assigned to an oral treatment by either amoxicillin (50 mg/kg per day) or erythromycin; infections of the follicular appendage were excluded. Both drugs were associated with the topical application of povidone iodine. The patients were evaluated openly at the seventh day of treatment for cure or marked improvement of the clinical features, indicating successful treatment.
Results:
Three patients were lost to follow-up. Treatment was successful in 57 of 64 patients treated with amoxicillin vs. 58 of 65 patients treated with erythromycin (P = 0.00).
Conclusions:
Amoxicillin was as efficacious as erythromycin in the treatment of severe pyoderma in Mali. Owing to its efficacy, added to high availability and low cost, this compound should be considered a first-line treatment of this disorder in this country, and perhaps in other countries where this condition presents in a similar way.
Insights
Amoxicillin and erythromycin showed similar efficacy in treating severe pyoderma (bacterial skin infection) in Mali. Amoxicillin
Area of Science:
- Dermatology
- Infectious Diseases
- Tropical Medicine
Background:
- Pyoderma, a common bacterial skin infection in tropical developing countries, is often caused by Streptococcus pyogenes.
- Current treatment guidelines lack specific recommendations for pyoderma, except during poststreptococcal glomerulonephritis epidemics.
- There is a need for effective and accessible treatments for pyoderma in resource-limited settings.
Purpose of the Study:
- To evaluate the efficacy of oral amoxicillin compared to oral erythromycin for treating severe pyoderma in Mali.
- To determine if amoxicillin is a suitable first-line treatment option for pyoderma in this region.
Main Methods:
- A randomized study involving 132 patients with severe pyoderma in Bamako, Mali.
- Patients received either oral amoxicillin (50 mg/kg/day) or oral erythromycin, alongside topical povidone iodine.
- Treatment success was assessed on day 7, defined as cure or marked improvement of clinical features.
Main Results:
- Treatment success rates were comparable between the two groups: 57 of 64 patients (amoxicillin) and 58 of 65 patients (erythromycin).
- The observed difference in efficacy between amoxicillin and erythromycin was not statistically significant (P = 0.00).
Conclusions:
- Oral amoxicillin demonstrated comparable efficacy to erythromycin in treating severe pyoderma in Mali.
- Amoxicillin's efficacy, availability, and low cost suggest its consideration as a first-line treatment for pyoderma in Mali and similar regions.
- Further research may support broader adoption of amoxicillin for pyoderma management in tropical developing countries.
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