Evidence of the Efficacy of Topical Treatments for Pyoderma| Treatment, level of evidence, cost (manufacturer, formulation, average wholesale price) | Evidence | Number of people in study | Results | Commentsa |
| Chlorhexidine gluconate (4 percent) detergent solutionSFTRETLevel of evidence: VI | Open-label, prospective cohort (versus nothing) (Taplin and others 1973) | 3,602 | 6.3 percent clinical pyoderma on postdischarge in the chlorhexidine group; 24 percent in the nonchlorhexidine group (no statistics reported) | -
Neonatal cord pyoderma -
Prophylaxis study
|
| Open-label, prospective cohort (versus 70 percent ethanol and versus nothing) (Taplin and others 1973) | 5,220 | Hospital A: 15.2 percent of group without and 2.1 percent with chlorhexidine prevented cord pyoderma; hospital B: 21.0 percent with ethanol and 1.0 percent with chlorhexidine prevented pyoderma (no statistics reported) | |
Povidone-iodine solution (Betadine)SFTRETLevel of evidence: IISFTRETCost: -
Alpharma U.S. Pharmaceutical Directory -
Solution, topical product, 10 percent, -
400 ml, US$5.46
| Double-blind RCT (fusidic acid cream plus povidone iodine versus placebo cream plus povidone iodine) (Seeberg and others 1984) | 160 | 92 percent improvement with fusidic acid and 88 percent with placebo | |
| Open-label, prospective cohort (versus salicylic acid) (Linder 1978) | 25 | 12/12 Betadine responded; 0/13 salicylic acid responded | | |
| Potassium permanganate | | | | |
| Level of evidence: none | | | | |
Cost: -
A-A Spectrum -
Crystal, NA -
500 gm, US$16.10
| | | | |
| MupirocinSFTRETLevel of evidence: ISFTRETSummary: Efficacy supported by two RCTs and several comparison studies; some concern about resistanceSFTRETCost: | Double-blind RCT (versus placebo vehicle) (Koning and others 2002) | 52 | 100 percent of mupirocin patients versus 85 percent of placebo (difference not significant) | |
| Double-blind, RCT (versus vehicle) (Daroczy 2002) | 106 | 85 percent of mupirocin versus 53 percent vehicle-treated patients (p = 0.007) | -
Secondarily infected dermatoses with S. aureus or S. pyogenes -
Outcome: marked or moderate improvement -
92 in final evaluation; no ITT
| |
| Open-label RCT (versus oral erythromycin) (Eells and others 1986) | 97 | 90 percent of erythromycin and 96 percent for mupirocin (no statistics given); long-term follow-up: 9 erythromycin versus 3 mupirocin patients developed new lesions (p = 0.05) | | |
| Open-label RCT (versus oral erythromycin) (Barton, Friedman, and Portilla 1988; | 60 | No significant difference in various evaluations of clinical efficacy except investigator's global evaluation (efficiency/safety performance) (p = 0.01) | | |
| Breneman 1990) Investigator-blinded, RCT (versus oral erythromycin) (McLinn 1988) | 75 | 93 percent mupirocin versus 96 percent erythromycin (no statistical difference)SFTRETRecurrence with erythromycin: 10 percent of patients with S. aureus and 6 percent of patients with S. pyogenes; recurrence with mupirocin: none. | | |
