Al-Samman D K / Pharmacie Globale (IJCP) 2014, 01 (03)

Available online at www.pharmacie-globale.info ISSN 0976-8157

Research Article
PHARMACIE GLOBALE
INTERNATIONAL JOURNAL OF COMPREHENSIVE PHARMACY

COMPARISON OF SINGLE-DOSE CEFTRIAXONE VERSUS SEVEN DAYS CEFADROXIL IN

ADDITION TO FUCIDIC ACID CREAM AS ADJUVANT THERAPY FOR THE TREATMENT OF
CHILDREN WITH IMPETIGO
Dina K Al-Samman*
Department of Pharmacology, College of Pharmacy, University of Mosul, Mosul, Iraq.
Received: 5 February 2014; Revised: 21 February 2014; Accepted: 28 February 2014; Available online: 5 March 2014

ABSTRACT
Objective of the current research is to compare the efficacy of short-course antibiotic therapies composed of
single intramuscular injection of ceftriaxone versus seven days cefadroxil suspension in addition to adjuvant
fusidic acid cream with the aim of achieving higher cure rates in impetigo, in a shorter time and to increase
compliance to therapy by using single dose. In addition, determining better and improved treatment option
for impetigo, resolving the soreness and the unsightly appearance, especially on the face. As well as
preventing recurrence and spread to other people. Diagnosis of impetigo was made clinically by
dermatologist and experienced family physicians, at Al-qudis health center for family medicine in Mosul city.
Enrollment criteria were to include 2-10 years of age with a clinical diagnosis of non-bullous moderate
impetigo with 11-20 lesions. Children with mild impetigo or who had extensive skin involvement, cellulite,
hypersensitivity to penicillin, cephalosporin or fusidic acid cream were excluded. Also exclude patients who
were immunocompromised, body temperature >38.5C or who had used topical or systemic antibiotics in
the previous 48hrs. Enrolled children were randomly assigned to 2 groups that received either single dose
ceftriaxone injection IM (50mg/kg/day) (group A) or cefadroxil suspension (30 mg/kg/day) in divided
doses every 12 hours for 7days (group B). In addition to systemic therapy, both groups received topical
treatment consisted of 20g fusidic acid cream mixed with 5g hydrocortisone cream (1%) as adjuvant
therapy. The patients were monitored on days 3 and 8. Patients were considered cured clinically if the
lesions resolved during therapy and did not recur within 10 days up to 1month following discontinuation of
the antibiotic. A total of 52 children were enrolled in the study. On day 3 of therapy, 22/25 children in the
group A (88%) had a cure or excellent response compared with 20/24 children in group B (83%) who had
the same response. On day 8 after therapy, 25/25 children in group A and 24/24 patients in group B who
completed the treatments were cured. Both types of therapy showed clinical successes and proved safe at
end of treatment. There was no relapse in the children reporting after the final visit, for about1 month after
therapy. Statistical analysis by the chi-square test showed no significant differences in outcome between
groups. A short-course treatments with single-dose I.M ceftriaxone, has comparable clinical cure rate to 7-
days cefadroxil .The single dose regimen is a good choice for children who might refuse take or vomit oral
medications and for families who might have compliance problems. Fusidic acid-steroid combination
products are useful for treating impetigo. Parents were universally pleased with the outcome and ease of
using the topical mixed cream as well as it was well-tolerated. The use of a dual therapy of both systemic and
topical antibiotic is recommended for rapid and effective treatment of impetigo with very few side effects.
Keywords: Ceftriaxone; Cefadroxil; Impetigo; Short-course antibiotic therapy; Adjuvant therapy.

INTRODUCTION
Impetigo (pyoderma) is a highly contagious bacterial skin
infection caused by the Gram-positive bacteria
Staphylococcus aureus and sometimes by Streptococcus
pyogenes.1,2 It is the fourth most common dermatological
skin disorders in children seen in general practice which
affects children 2 to 6 years of age and infants, although it
can occur in any age group.3,4
*Corresponding Author:
Dina K Al-Samman
Lecturer, Department of Pharmacology,
College of Pharmacy, University of Mosul, Mosul, Iraq.
Contact no: +7701807610; Email: raheek_3@yahoo.ca
Impetigo can occur as a primary infection or secondary to
pre-existing skin conditions, such as eczema, scabies,
insect bites, or burns. Although it commonly occurs when
bacteria enter the skin through cuts or insect bites, it can
also develop in skin that's perfectly healthy.2,5,6 Impetigo is
highly contagious and can spread easily, in schools and
child care settings, from person to person primarily by
direct contact with infected lesions, and indirectly via
fomites.3,7 It tends to affect exposed areas, such as the face
especially around a child's nose, mouth and extremities.2,8
The diagnosis usually is made clinically, mostly by general

1 Pharmacie Globale (IJCP), Vol. 05, Issue 01