Background and Aims: Antiseptics are increasingly being used to treat impetigo in order to reduce the development of antimicrobial resistance due to topical antibiotic prescribing. Our recent randomised controlled trial compared treatment of non-severe impetigo using topical antiseptic hydrogen peroxide and topical antibiotic fusidic acid. Use of antiseptic was not shown to be non-inferior overall when compared to antibiotics. However, antiseptics led to non-inferior treatment outcomes when participants with impetigo affecting multiple body areas were excluded, implying treatment of localised impetigo was non-inferior with topical antiseptics. Higher rates of residual bacteria, both Staphylococcus aureus and Streptococcus pyogenes, were identified on the skin at the end of treatment with antiseptic when compared to antibiotic. This raised questions about the potential for early recurrences in this group. The aim of this study was to follow-up trial participants to identify differences in time to next skin and soft tissue infection (SSTI) between those treated with antiseptic and antibiotic. Method: Health records for each participant, including school health records, community prescriptions, and hospital visits, were reviewed for each study participant to identify presentations for SSTIs and compared using Kaplan Meier survival curves and Log rank tests. Results: 391/400 participants had complete follow-up data. Following completion of the trial 28/154 (18%) of participants given antibiotic and 34/164 (21%) of participants who received antiseptic experienced a SSTI within 30 days. There was no significant difference demonstrated between time to first recurrence (Log rank test X2 0.4, p=0.5). Conclusion: When treating non-severe, localised impetigo with topical antiseptics, more bacteria remain on the skin after treatment, but based on this small sample, there is no evidence of early recurrence of SSTI in those treated with topical antiseptics when compared to topical antibiotics. This provides support for the treatment of non-severe impetigo with antiseptics, a practice that is increasing in several countries, including the UK and New Zealand.
Primhak et al. (Thu,) studied this question.