impetigo

Scabies and Impetigo: Could Adding an Antibiotic Improve Treatment?

Combination treatment with azithromycin and ivermectin is associated with similar decreases in the prevalence of scabies and impetigo compared with ivermectin alone, according to a new study.

For their study, the researchers evaluated 6 communities in the Solomon Islands in which the prevalence of scabies and impetigo is high, randomly assigning each community to treatment with either ivermectin-based mass drug administration (MDA) or ivermectin-based MDA co-administered with azithromycin.

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The prevalence of scabies and impetigo was ascertained at baseline and 12 months. In addition, impetigo lesions swabs were collected at baseline, 3 months, and 12 months in order to assess antimicrobial resistance.

The prevalence of scabies and impetigo in patients treated with ivermectin only was:

  • 11.8% and 10.1% at baseline, respectively
  • 1.0% and 2.5% at 12 months, respectively

Among patients who received combined treatment, the prevalence of scabies and impetigo was:

  • 9.2% and 12.1% at baseline, respectively
  • 0.7% and 3.3% at 12 months, respectively

Study findings indicated that the proportion of impetigo lesions containing Staphylococcus aureus (S aureus) did not change from baseline to 12 months, with no significant difference between treatment groups (80% at baseline vs 86% at 12 months).

However, a significant drop in the proportion of lesions containing pyogenic streptococci was observed (63% at baseline vs 23% at 12 months).

Approximately 53% of S aureus isolates among patients on combination treatment were macrolide-resistant, but no resistant strains were evident at 12 months.

“Co-administration of azithromycin with ivermectin led to similar decreases in scabies and impetigo prevalence compared to ivermectin alone,” the researchers concluded.

—Christina Vogt

Reference:

Marks M, Toloka H, Baker C, et al. Randomized trial of community treatment with azithromycin and ivermectin mass drug administration for control of scabies and impetigo [Published online July 7, 2018]. Clin Infect Dis. https://doi.org/10.1093/cid/ciy574