Contagious impetigo: spectrum of causative and implications for treatment

Objective: The aim of this prospective study was to compare the clinical pi cture of contagious impetigo (C.I.) with the causative organism and to gene rate data of the susceptibility of bacteria as the basis for adequate thera py. Patients and methods: In 126 patients with C.I. (86 children, 66 of them yo unger than 10 years) bacterial swabs were taken and antibiotic sensitivity testing for isolated organisms was tested. Results: In all cases in which contents of vesicles or pustules were analys ed, Staphylococcus aureus was the only pathogen isolated. In non-bullous va riants of C.I. Staphylococcus aureus was the most often isolated organism a s well. Both staphylococci and streptococci were isolated in 12 cases, wher eas in just 9 cases streptococci were the only pathogen detected. All Staph ylococcus aureus isolates were sensitive to flucloxacillin and cefotaxime. Erythromycin-resistance amounted to more than 20 percent. The percentage of resistant staphylococci against the predominantly topically applied antibi otics fusidinic acid and mupirocin was 2 and 0 per cent, respectively. Conclusion: For all manifestations of C.I. Staphylococcus aureus is at pres ent the leading organism which has to be taken into consideration for treat ment. If oral antibiotic therapy is indicated, penicillinase-stable penicil lins or cephalosporins, preferably of the cefalexin-type, are the drugs of choice. Macrolides are no longer recommended for inititiating of C.I. treat ment.