Impetigo and scabies – Disease burden and modern treatment strategies

Yeoh, Daniel K; Bowen, Asha C; Carapetis, Jonathan R.

doi:10.1016/j.jinf.2016.04.024

Cited by 37 publications

(29 citation statements)

References 64 publications

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“…The significant individual complications of scabies, pediculosis and impetigo are well documented[3, 4, 7–9, 17, 18]. Scabies, impetigo and pediculosis are highly transmissible and the assessment and treatment of household members is recommended as important public health control measures to prevent onward transmission and re-infection[33, 34].…”

Section: Discussionmentioning

confidence: 99%

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Are scabies and impetigo “normalised”? A cross-sectional comparative study of hospitalised children in northern Australia assessing clinical recognition and treatment of skin infections

et al. 2017

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BackgroundComplications of scabies and impetigo such as glomerulonephritis and invasive bacterial infection in Australian Aboriginal children remain significant problems and the overall global burden of disease attributable to these skin infections remains high despite the availability of effective treatment. We hypothesised that one factor contributing to this high burden is that skin infection is under-recognised and hence under-treated, in settings where prevalence is high.MethodsWe conducted a prospective, cross-sectional study to assess the burden of scabies, impetigo, tinea and pediculosis in children admitted to two regional Australian hospitals from October 2015 to January 2016. A retrospective chart review of patients admitted in November 2014 (mid-point of the prospective data collection in the preceding year) was performed. Prevalence of documented skin infection was compared in the prospective and retrospective population to assess clinician recognition and treatment of skin infections.Results158 patients with median age 3.6 years, 74% Aboriginal, were prospectively recruited. 77 patient records were retrospectively reviewed. Scabies (8.2% vs 0.0%, OR N/A, p = 0.006) and impetigo (49.4% vs 19.5%, OR 4.0 (95% confidence interval [CI 2.1–7.7) were more prevalent in the prospective analysis. Skin examination was only documented in 45.5% of cases in the retrospective review. Patients in the prospective analysis were more likely to be prescribed specific treatment for skin infection compared with those in the retrospective review (31.6% vs 5.2%, OR 8.5 (95% CI 2.9–24.4).ConclusionsScabies and impetigo infections are under-recognised and hence under-treated by clinicians. Improving the recognition and treatment of skin infections by clinicians is a priority to reduce the high burden of skin infection and subsequent sequelae in paediatric populations where scabies and impetigo are endemic.

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Section: Discussionmentioning

confidence: 99%

“…There are effective and relatively well tolerated treatments for skin infections, yet the burden of disease appears to be increasing or at least stable in endemic settings[18–20]. Translation of these evidence-based treatments depends on the successful recognition and diagnosis of skin infection by clinicians.…”

Section: Introductionmentioning

confidence: 99%

Are scabies and impetigo “normalised”? A cross-sectional comparative study of hospitalised children in northern Australia assessing clinical recognition and treatment of skin infections

et al. 2017

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“…The incidence of complications of skin infections has decreased for children from affluent populations but remains problematic in resource‐poor settings . These complications include invasive S. aureus and S. pyogenes infections and post‐infectious sequelae of S. pyogenes .…”

Section: Serious Sequelae Of Untreated Skin Infectionsmentioning

confidence: 99%

“…The incidence of complications of skin infections has decreased for children from affluent populations but remains problematic in resource-poor settings. 38 These complications include invasive S. aureus and S. pyogenes infections and postinfectious sequelae of S. pyogenes. Risk factors for the development of invasive GAS disease from a superficial infection include younger age, concurrent viral infection, household crowding, strain virulence, and impaired host immunity.…”

Section: Serious Sequelae Of Untreated Skin Infectionsmentioning

confidence: 99%

Skin infections in Australian Aboriginal children: a narrative review

Davidson

Knight

Bowen

2019

Medical Journal of Australia

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Summary Impetigo, scabies, cellulitis and abscesses are common in Australian Aboriginal children. These conditions adversely affect wellbeing and are associated with serious long term sequelae, including invasive infection and post‐infectious complications, such as acute post‐streptococcal glomerulonephritis and acute rheumatic fever, which occurs at the highest documented rates in the world in remote Aboriginal communities. Observational research in remote communities in northern Australia has demonstrated a high concurrent burden of scabies and impetigo and their post‐infectious complications. Few data are available for other Australian states, especially for urban Aboriginal children; however, nationwide hospital data indicate that the disparity between Aboriginal and non‐Aboriginal children in skin infection prevalence also exists in urban settings. The Australian National Healthy Skin Guideline summarises evidence‐based treatment of impetigo, scabies and fungal infections in high burden settings such as remote Aboriginal communities. It recommends systemic antibiotics for children with impetigo, and either topical permethrin or oral ivermectin (second line) for the individual and their contacts as equally efficacious treatments for scabies. β‐Lactams are the treatment of choice and trimethoprim–sulfamethoxazole and clindamycin are effective alternatives for treatment of paediatric cellulitis. Abscesses require incision and drainage and a 5‐day course of trimethoprim–sulfamethoxazole or clindamycin. Addressing normalisation of skin infections and the social determinants of skin health are key challenges for the clinician. Research is underway on community‐wide skin health programs and the role for mass drug administration which will guide future management of these common, treatable diseases.

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“…As decided by the AMS Committee, a separate guideline for inpatient management will also be produced with clear links from the community-based Protocol to a hospital-based prescribing protocol. This hospital protocol for more severe infections requiring admission is under-way and will be informed by a concurrent study of diagnosis, treatment, and prescribing of impetigo in Aboriginal children once hospitalized (13). …”

Section: What Did We Learn?mentioning

confidence: 99%

Community-Based Prescribing for Impetigo in Remote Australia: An Opportunity for Antimicrobial Stewardship

Oliver

Cush

Ward

2017

Front. Public Health

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BackgroundTo support antibiotic prescribing for both hospital and community-based health professionals working in remote North Western Australia, a multidisciplinary Antimicrobial Stewardship (AMS) Committee was established in 2013. This Committee is usually focused on hospital-based prescribing. A troubling increase in sulfamethoxazole/trimethoprim resistance in Staphylococcus aureus antibiograms from 9 to 18% over 1 year prompted a shift in gaze to community prescribing.What we didFinding a paucity of relevant research, we first investigated contextual factors influencing local prescribing. We also designed a systematic survey of experts with experience relevant to our setting using a structured response survey (12 questions) to better understand specific AMS risks. Using these findings, recommendations were formulated for the AMS Committee.What we learnedPrescribing recommendations in a regional Skin Infections Protocol had previously been altered in December 2014. From 15 experts, we received 9 comprehensive responses (60%) about AMS risks in community prescribing. If feasible, prescribing audits also would have been valuable. Ten recommendations regarding specific antibiotic recommendations were submitted to the AMS Committee.Strengthening AMS in remote settingsAs AMS Committees in Australia usually focus on hospital-based prescribing, novel methods such as external expert opinion could inform deliberations about community-based prescribing. Our approach meant that this AMS Committee was able to intervene in the 2017 organizational review of the regional Skin Infections Protocol used by prescribers likely unaware of AMS risks. This experience demonstrates the value of incorporating AMS principles in community-based prescribing in context of a remote setting.

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Impetigo and scabies – Disease burden and modern treatment strategies

Cited by 37 publications

References 64 publications

Are scabies and impetigo “normalised”? A cross-sectional comparative study of hospitalised children in northern Australia assessing clinical recognition and treatment of skin infections

Are scabies and impetigo “normalised”? A cross-sectional comparative study of hospitalised children in northern Australia assessing clinical recognition and treatment of skin infections

Skin infections in Australian Aboriginal children: a narrative review

Community-Based Prescribing for Impetigo in Remote Australia: An Opportunity for Antimicrobial Stewardship

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