{Reference Type}: Journal Article
{Title}: International comparison of guidelines for management of impetigo: a systematic review.
{Author}: Hall LM;Gorges HJ;van Driel M;Magin P;Francis N;Heal CF;
{Journal}: Fam Pract
{Volume}: 0
{Issue}: 0
{Year}: Jun 2021 29
{Factor}: 2.29
{DOI}: 10.1093/fampra/cmab066
{Abstract}: <B>BACKGROUND: </B>Impetigo is a common superficial skin infection that affects people worldwide and is usually treated with antibiotics; therefore, its management has implications for global antibiotic stewardship.<BR><B>OBJECTIVE: </B>This systematic review and narrative synthesis compares and contrasts international impetigo management guidelines.<BR><B>METHODS: </B>Guidelines for treatment of impetigo that were produced by a national authority; available to primary care physicians; and published since 2008 were included. Following a comprehensive search strategy, data extraction from eligible studies was performed independently in duplicate. Details of antiseptic and antibiotic treatment; methicillin-resistant Staphylococcus aureus treatment; and conservative management and preventative measures were tabulated and analysed descriptively.<BR><B>RESULTS: </B>Fifty-one guidelines were included from 42 different countries. All guidelines recommended systemic antibiotics, 78% of these only for widespread lesions or failure of topical antibiotic treatment. The first-line systemic antibiotic treatment was restricted to narrow-spectrum options in 21 (41%) whilst 7 (14%) recommended only broad-spectrum antibiotics first-line. Thirty-four (67%) guidelines included recommendations for topical antibiotic use. Twenty guidelines (39%) did not mention antiseptic treatment for impetigo. Guidelines did not always provide clear indications for different treatment options.<BR><B>CONCLUSIONS: </B>Despite potentially equal efficacy to systemic antibiotics, only two-thirds of guidelines include topical antibiotic options. Many fail to include recommendations for non-antibiotic treatments such as antiseptics, preventative measures and conservative management, despite potential for antibiotic-sparing. Provision of clear definitions of disease severity and indications for treatment would enhance the ability of clinicians to adhere to recommendations.<BR><B>UNASSIGNED: </B>PROSPERO CRD42018117770.