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Abstract：
Impetigo affects approximately 162 million children worldwide at any given time. Lack of consensus on the most effective treatment strategy for impetigo and increasing antibiotic resistance continue to drive research into newer and alternative treatment options. We conducted a systematic review to assess the effectiveness of new treatments for impetigo in endemic and nonendemic settings.
We searched PubMed, MEDLINE, CINAHL, Web of Science, and Embase via Scopus for studies that explored treatments for bullous, nonbullous, primary, and secondary impetigo published between August 1, 2011, and February 29, 2020. We also searched online trial registries and hand-searched the reference lists of the included studies. We used the revised Cochrane risk of bias (version 2.0) tool for randomized trials and the National Heart, Lung, and Blood Institute for nonrandomized uncontrolled studies to assess the risk of bias.
We included 10 studies that involved 6651 participants and reported on 9 treatments in the final analysis. Most clinical trials targeted nonbullous impetigo or did not specify this. The risk of bias varied among the studies. In nonendemic settings, ozenoxacin 1% cream appeared to have the strongest evidence base compared with retapamulin and a new minocycline formulation. In endemic settings, oral co-trimoxazole and benzathine benzylpenicillin G injection were equally effective in the treatment of severe impetigo. Mass drug administration intervention emerged as a promising public health strategy to reduce the prevalence of impetigo in endemic settings.
This review highlights the limited research into new drugs used for the treatment of impetigo in endemic and nonendemic settings. Limited recent evidence supports the use of topical ozenoxacin or retapamulin for impetigo treatment in nonendemic settings, whereas systemic antibiotics and the mass drug administration strategy have evidence for use in endemic settings. Given the troubling increase in resistance to existing treatments, there is a clear need to ensure the judicious use of antibiotics and to develop new treatments and alternative strategies; this is particularly important in endemic settings. PROSPERO identifier: CRD42020173042.
We searched PubMed, MEDLINE, CINAHL, Web of Science, and Embase via Scopus for studies that explored treatments for bullous, nonbullous, primary, and secondary impetigo published between August 1, 2011, and February 29, 2020. We also searched online trial registries and hand-searched the reference lists of the included studies. We used the revised Cochrane risk of bias (version 2.0) tool for randomized trials and the National Heart, Lung, and Blood Institute for nonrandomized uncontrolled studies to assess the risk of bias.
We included 10 studies that involved 6651 participants and reported on 9 treatments in the final analysis. Most clinical trials targeted nonbullous impetigo or did not specify this. The risk of bias varied among the studies. In nonendemic settings, ozenoxacin 1% cream appeared to have the strongest evidence base compared with retapamulin and a new minocycline formulation. In endemic settings, oral co-trimoxazole and benzathine benzylpenicillin G injection were equally effective in the treatment of severe impetigo. Mass drug administration intervention emerged as a promising public health strategy to reduce the prevalence of impetigo in endemic settings.
This review highlights the limited research into new drugs used for the treatment of impetigo in endemic and nonendemic settings. Limited recent evidence supports the use of topical ozenoxacin or retapamulin for impetigo treatment in nonendemic settings, whereas systemic antibiotics and the mass drug administration strategy have evidence for use in endemic settings. Given the troubling increase in resistance to existing treatments, there is a clear need to ensure the judicious use of antibiotics and to develop new treatments and alternative strategies; this is particularly important in endemic settings. PROSPERO identifier: CRD42020173042.
摘要：
在任何给定时间，脓疱病都会影响全球约1.62亿儿童。对脓疱病最有效的治疗策略缺乏共识和增加的抗生素耐药性继续推动研究进入更新和替代治疗方案。我们进行了系统评价，以评估流行和非流行环境中脓疱病新疗法的有效性。
我们搜索了PubMed,MEDLINE,CINAHL,WebofScience,并通过ScopusEmbase进行探索大疱性治疗方法的研究，非大疱性，小学,和继发性脓疱病在2011年8月1日至2020年2月29日之间发布。我们还搜索了在线试验登记处，并手工搜索了纳入研究的参考列表。我们使用修订后的Cochrane偏倚风险（2.0版）工具进行随机试验和国家心脏，肺，和血液研究所进行非随机非对照研究，以评估偏倚风险。
我们纳入了10项研究，涉及6651名参与者，并在最终分析中报告了9种治疗方法。大多数临床试验针对非大疱性脓疱病或没有具体说明这一点。偏倚的风险在研究中有所不同。在非地方性环境中，与retapamulin和一种新型米诺环素相比，1%奥替诺沙星乳膏似乎具有最强的证据基础。在地方性环境中，口服复方新诺明和苄星青霉素G注射液在治疗重度脓疱疮方面同样有效.大规模药物管理干预已成为一种有前途的公共卫生策略，可降低流行环境中脓疱病的患病率。
这篇综述强调了在地方性和非地方性环境中用于治疗脓疱病的新药的有限研究。最近有限的证据支持在非地方性环境中使用局部奥扎诺沙星或retapamulin治疗脓疱病。而全身性抗生素和大量药物给药策略有证据可用于地方性环境。鉴于对现有治疗方法的耐药性令人不安地增加，明确需要确保合理使用抗生素,并开发新的治疗方法和替代策略;这在地方性环境中尤为重要.PROSPERO标识符：CRD42020173042。
我们搜索了PubMed,MEDLINE,CINAHL,WebofScience,并通过ScopusEmbase进行探索大疱性治疗方法的研究，非大疱性，小学,和继发性脓疱病在2011年8月1日至2020年2月29日之间发布。我们还搜索了在线试验登记处，并手工搜索了纳入研究的参考列表。我们使用修订后的Cochrane偏倚风险（2.0版）工具进行随机试验和国家心脏，肺，和血液研究所进行非随机非对照研究，以评估偏倚风险。
我们纳入了10项研究，涉及6651名参与者，并在最终分析中报告了9种治疗方法。大多数临床试验针对非大疱性脓疱病或没有具体说明这一点。偏倚的风险在研究中有所不同。在非地方性环境中，与retapamulin和一种新型米诺环素相比，1%奥替诺沙星乳膏似乎具有最强的证据基础。在地方性环境中，口服复方新诺明和苄星青霉素G注射液在治疗重度脓疱疮方面同样有效.大规模药物管理干预已成为一种有前途的公共卫生策略，可降低流行环境中脓疱病的患病率。
这篇综述强调了在地方性和非地方性环境中用于治疗脓疱病的新药的有限研究。最近有限的证据支持在非地方性环境中使用局部奥扎诺沙星或retapamulin治疗脓疱病。而全身性抗生素和大量药物给药策略有证据可用于地方性环境。鉴于对现有治疗方法的耐药性令人不安地增加，明确需要确保合理使用抗生素,并开发新的治疗方法和替代策略;这在地方性环境中尤为重要.PROSPERO标识符：CRD42020173042。
