Modern approaches to treatment of superficial pyoderma

Abstract

Impetigo is the most common bacterial skin infection in children. The disease has two forms: nonbullous and bullous, of which nonbullous is the most common (70 %). Impetigo is caused by Staphylococcus aureus, Streptococcus pyogenes, or their combinations. In nonbullous impetigo, methicillin­resistant strains (MRSA) of S. aureus are most often detected. For the colonization of staphylococcus and streptococcus, the necessary conditions are damage to the integrity of the skin and violation of the composition of the usual microflora of the skin. Patients with inflammatory skin diseases are most often colonized by S. aureus and are at high risk for developing MRSA infections. In bullous impetigo, the rash elements are represented by bullae which quickly burst with the formation of surface erosion and a yellow crust. Nonbullous impetigo is manifested by vesicles, pustules, crusts. Typically, impetigo is clinically diagnosed. Suspicion of MRSA occurs in cases of spontaneous abscess or cellulitis, or if lesions are not eliminated by the recommended initial treatment with antibiotics. Topical therapy is the first line of treatment for uncomplicated nonbullous and bullous impetigo. If the lesion is limited to a small area (up to 6 cm2), the treatment involves soaking the crusts, exfoliating them and applying antimicrobial ointments (fusidic acid or a combination of neomycin and bacitracin) (EBM Guidelines, 2018). With more diffuse lesions, systemic antibiotic therapy is prescribed. In treatment of patients with eczema, topical and systemic antimicrobials with topical steroids are used. The combination of the aminoglycoside antibiotic neomycin and the polypeptide antibiotic bacitracin is presented at the Ukrainian pharmaceutical market as Baneocin drug. This combination has a pronounced synergistic effect on S. aureus, S. pyogenes and P. aeryginosa. An important advantage of Baneocin is its availability in two forms (powder and ointment), which allows the use of this drug at different stages of the infection process.