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On-line version ISSN 1806-4841
An. Bras. Dermatol. vol.87 no.5 Rio de Janeiro Sept/Oct. 2012
Luciana Baptista Pereira
Master - Assistant Professor of Dermatology at the Universidade Federal de Minas Gerais(UFMG). Teacher at the Pediatric Dermatology Outpatients Clinic of the Hospital das Clínicas of the Universidade Federal de Minas Gerais(HC-UFMG) - Belo Horizonte (MG), Brazil
On the March/April 2012 edition Empinotti et al1 quoted the streptococcus as the main agent of nonbullous impetigo. It terms of treatment they reported the possibility of using common penicillin to treat disseminated lesions. According to the world literature, conflicting data is found.
S. aureus was the predominant organism in crusty (non-bullous) impetigo during the decades of 1940 and 1950 and, subsequently, the prevalence of streptococcus increased. However, in studies con ducted during the last three decades, there was a resurgence of S. aureus as the main agent in crusty impetigo. S. aureus, isolated or in combination with streptococcus, is responsible for 80% of the cases, and S. aureus is the most recovered agent in an isolated form. 2,3 Despite the fact that Brazilian articles related to the epidemiology of impetigo were not found, these data are repeated in different countries: United States, Israel, Thailand, Japan, French Guiana, India, Chile, Norway.
In terms of treatment, the antibiotic spectrum to be chosen should cover staphylococcus and streptococcus for both bullous and non-bullous impetigo. 4 As such, benzathine penicillin and others sensitive to penicillinases are not indicated in the treatment of impetigo. In a systematic review conducted by The Cochrane Library it was considered that V penicillin had a worse response than erythromycin and cloxacillin.5 Another interesting aspect reported was the absence of glomerulonephritis as a complication of impetigo, a fact that could reflect the reduced importance of streptococcus in impetigo.
I consider it important to report these data from the literature, as they lead to a considerable change in the conduct of a patient with impetigo.
1. Empinotti JC, Uyeda H, Ruaro RT, Galhardo AP, Bonatto DC. Piodermites.An Bras Dermatol.2012;87:281-8. [ Links ]
2. Brook I, Frazier EH, Yeager Jk. Microbiology of nonbullous impetigo. PediatrDermatol. 1997;14:192-5. [ Links ]
3. Dagan R. Impetigo in childhood: changing epidemiology and new treatments. Pediatrics Ann. 1993;22:235-40. [ Links ]
4. George A, Rubin G. A systematic review and meta-analysis of treatments for impetigo.Br J Gen Pract. 2003;53:480-7. [ Links ]
5. Koning S, van der Sande R, Verhagen AP, van Suijlekom-Smit LW, Morris AD, Butler CC, et al. Interventions for impetigo. Cochrane Database Syst Rev. 2012;1:CD003261. [ Links ]
Luciana Baptista Pereira
Rua Domingos Vieira, 300/505 Santa Efigênia
30150-240 Belo Horizonte
Received on 03.06.2012.
Approved by the Advisory Board and accepted for publication on 14.06.2012.
Financial Support: none.
Conflict of Interests: none.
* Work performed at the Dermatology Service of the Hospital das Clínicas of the Universidade Federal de Minas Gerais (HC-UFMG) - Belo Horizonte (MG), Brazil.