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The natural history of streptococcal skin infection: prevention with topical antibiotics
Insights
Topical antibiotics significantly reduced streptococcal pyoderma in children. This study highlights skin carriage of group A streptococci and minor trauma as key factors in infection development.
Area of Science:
- Dermatology
- Pediatrics
- Infectious Diseases
Background:
- Group A streptococci (GAS) are a common cause of skin infections, particularly in children.
- Streptococcal pyoderma is prevalent in day care settings, often linked to minor skin trauma.
- Understanding the natural history and prevention of streptococcal skin infections is crucial for pediatric health.
Purpose of the Study:
- To investigate the natural history of streptococcal skin infection in a pediatric day care population.
- To evaluate the efficacy of a triple antibiotic ointment in preventing streptococcal pyoderma.
- To identify risk factors associated with the development of streptococcal skin infections.
Main Methods:
- A double-blind, placebo-controlled study involving 59 children in a rural day care setting.
- Comparison of a triple antibiotic ointment (bacitracin, polysporin, neomycin) versus placebo for minor skin trauma.
- Weekly cultures of normal skin and lesion cultures when present over a 15-week period.
Main Results:
- 81% of children had positive normal skin cultures for GAS at some point during the study.
- 19 children (32%) developed streptococcal pyoderma.
- Infection rates were significantly lower in the topical antibiotic group (15%) compared to placebo (47%; p=0.01).
Conclusions:
- Normal skin carriage of GAS is a significant precursor to pyoderma.
- Minor skin trauma, such as insect bites and abrasions, predisposes children to infection.
- Topical antibiotics show promise in preventing streptococcal pyoderma, especially in high-risk children.
Abstract:
An investigation on the natural history of streptococcal skin infection was done in fifty-nine children in a rural day care setting. A double-blind study for prevention of streptococcal pyoderma was done during the peak season for skin infection. Triple antibiotic ointment, containing bacitracin, polysporin, and neomycin, was compared to placebo ointment. Ointments were applied thrice daily for minor skin trauma; mosquito bites and abrasions were predominant. Cultures of normal skin surfaces were taken for group A streptococci each week of the 15-week study period. Skin lesions were cultured whenever present. Eighty-one percent of the fifty-nine patients had positive normal skin cultures on one or more occasions. Nineteen children (32%) developed streptococcal pyoderma. Infection occurred significantly more often in children using placebo ointment than in those using topical antibiotic (47% vs 15%; p = 0.01). The infecting strain was first recovered from normal skin surfaces in 67% of placebo patients and in two of the four patients using antibiotic ointment. This study further confirms the importance of skin carriage of group A streptococci as a precursor to pyoderma and demonstrates the importance of minor skin trauma as a predisposing factor. Topical antibiotics may be useful in preventing streptococcal pyoderma, especially in children known to be at increased risk for such infection.