Comparison of efficacy and cost-effectiveness of topical fusidic acid and topical mupirocin in the treatment of impetigo

Abstract

Background: Impetigo is a highly contagious skin infection of the superficial epidermis that most often affects the age group of 2–5 years children, although it can occur in any age group. Topical antibiotics as the advantage of being applied only where needed, minimizing antibiotic resistance and avoiding gastrointestinal and other systemic adverse effects. Aims and Objectives: This study aimed to evaluate the efficacy and cost-effectiveness of topical fusidic acid and mupirocin in the treatment of Impetigo. Materials and Methods: This was an open-label, prospective study conducted on 100 patients of impetigo. The present study was conducted at the Department of Pharmacology in collaboration with the Department of Dermatology of Osmania General Hospital, Hyderabad, India, from August 2016 to July 2017. Patients were randomly allocated to two groups, namely Group I receiving topical fusidic acid 2% and Group II receiving topical mupirocin 2% thrice daily for 1 week. At the end of the 1st week, a detailed clinical examination was performed. Scoring System of Impetigo (SSI), number of lesions, and size of existing lesions were measured. The clinical outcome was graded as mild-to-moderate (SSI score 1 or 2 and presence of lesions) and good (SSI score 0 and no lesions). Results: Statistical analysis was performed using the Student’s paired t-test and unpaired t-test. P < 0.05 was considered statistically significant. In the fusidic acid group, the number of lesions (mean ± SD) declined from 4.24 ± 1.17 to 0.24 ± 0.82, wound area decreased from 3.24 ± 0.95 to 0.34 ± 1.18, and SSI decreased from 2.32 ± 0.47 to 0.14 ± 0.49. While in the mupirocin group, the number of lesions declined from 4.16 ± 1.11 to 0.14 ± 0.70, wound area decreased from 3.45 ± 1.14 to 0.17 ± 0.85, and SSI decreased from 2.44 ± 0.50 to 0.08 ± 0.39. All these parameters were statistically significant. Adverse events in both groups were mild and did not require any specific treatments. Cost incurred to treat one case successfully was 46 Indian National Rupee (INR) for fusidic acid and 72 INR for mupirocin. Conclusion: In this study, at the end of the 1st week, efficacy is 92% in Group I receiving topical fusidic acid 2% and 96% in Group II receiving topical mupirocin 2%. There is no statistically significant difference between the two groups (P > 0.05) as calculated by the unpaired t-test. The cost incurred to treat one case successfully is less with fusidic acid (INR 46) as compared to mupirocin (INR 72) (cost-effectiveness). Hence, fusidic acid is more cost-effective than mupirocin.