Interventions for impetigo

 

Characteristics of included studies [ordered by study ID]

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Methods	Time NR; Japan; range of infections (impetigo 13/265)
Participants	Age 15 to 82 years M/F 150/115 (all participants) Mainly S.aureus
Interventions	A: cefdinir 100 mg, 3 td B: cefaclor 250 mg, 3 td
Outcomes	Outcomes of the trial 1) 10 days, excellent/good/poor
Notes	-
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Insufficient information was available in the abstract.
Allocation concealment (selection bias)	Unclear risk	Insufficient information was available in the abstract.
Blinding (performance bias and detection bias) patient	Unclear risk	Quote: "....double-blind." Comment: There was unclear blinding of the outcome assessor and caregiver. The participant was probably blinded (see also Figure 2). The test drug packages also included placebo capsules.
Incomplete outcome data (attrition bias) All outcomes	Low risk	35/300 participants were omitted in the analysis: 16/147 in the cefdinir group (8 due to no or delayed visit to hospital, others for several reasons), 19/153 in the cefaclor group (8 due to no or delayed visit to hospital, others for several reasons) (see table 2).
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	Unclear risk	There was no baseline imbalance.
Randomised?	Unclear risk	Insufficient information was available in the abstract.
Were both inclusion and exclusion criteria specified?	Unclear risk	Insufficient information was available in the abstract.

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Methods	Time NR; Japan; range of skin infections (including impetigo 18/259)
Participants	All ages M/F 162/97 Mainly S.aureus (data for all participants)
Interventions	A: lomefloxacin 200 mg, 3 td B: norfloxacin 200 mg, 3 td
Outcomes	Outcomes of the trial 1) 7 days, cured/improved
Notes	-
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Insufficient information was available in the abstract.
Allocation concealment (selection bias)	Unclear risk	This was unclear.
Blinding (performance bias and detection bias) patient	Unclear risk	Quote: "...a double-blind clinical trial." It was unclear who was blinded (and how). The outcome assessor and caregiver were probably not blinded. The participant was probably blinded (see Figure 1 Dosing schedule).
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	33/291 participants were omitted in the analysis: 15/147 in the NY-198 group, 17/144 in the norfloxacin group. There was insufficient information in the abstract and figures.
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	Unclear risk	There was no baseline imbalance.
Randomised?	Low risk	Quote: "...were randomly allocated to one of the two drugs."
Were both inclusion and exclusion criteria specified?	Unclear risk	Inclusion (quote): "...skin and soft tissue infections, patients > 15 years". There was no exclusion criteria.

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Methods	Time NR; Mexico city, Mexico; range of skin infections (including impetigo 55/61)
Participants	Average age 7 years M/F 30/31 S.aureus 67%
Interventions	A: mupirocin ointment 2%, 3 td, 5 to 10 days B: dicloxacillin 250 mg, 4 td, 5 to 10 days
Outcomes	Outcomes of the trial 1) 10 days, cure
Notes	Open trial
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Insufficient information was available.
Allocation concealment (selection bias)	Unclear risk	This was not mentioned in the article.
Blinding (performance bias and detection bias) patient	High risk	Quote: "In an open trial..." Participants received capsules or ointment. Neither the participant, caregiver, nor outcome assessor were blinded.
Incomplete outcome data (attrition bias) All outcomes	Low risk	3/61 participants were omitted in the analysis: 2/29 in the mupirocin group, 1/32 in the dicloxacillin group. Reasons for being non-evaluable for clinical outcome were not specified (but this was a small %).
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	High risk	Baseline imbalance: more severe impetigo in the mupirocin group (9/32 vs 3/29, Table 1). There was no data on compliance.
Randomised?	Low risk	Quote: "After obtaining informed consent, patients were randomly divided into two treatment groups."
Were both inclusion and exclusion criteria specified?	Low risk	Quote: "...pediatric patients with skin infections of sufficient severity to require treatment with a antibiotic." Quote: "Patients who...were excluded from the trial."

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Methods	June to August 1986; Missouri, USA; outpatients; only impetigo
Participants	Children (age NR) M/F 29/32 S.aureus 35/65, Streptococcus 2/65, both: 30% PE
Interventions	A: penicillin V 50 mg/kg/day in 4 dd, 10 ds B: erythromycin 40 mg/kg/day in 4 dd, 10 ds
Outcomes	Outcomes of the trial 1) 7 days, failure
Notes	-
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Insufficient information was available about sequence generation.
Allocation concealment (selection bias)	Low risk	Quote: "The patients were assigned to receive either erythromycin or penicillin in a random, double-blind fashion by a pharmacist." Comment: Participants and investigators enrolling participants could not foresee assignment.
Blinding (performance bias and detection bias) patient	Unclear risk	See above - it was not specified how this was done. It is unclear whether the caregiver, participant, or outcome assessor was blinded.
Incomplete outcome data (attrition bias) All outcomes	High risk	42/71 participants were omitted in the analysis - reasons and numbers were not specified for each group (6 due to negative culture, 21 not evaluable for effectiveness (not further specified), 6 due to no ascertained compliance, 3 due to no growth of S. aureus alone, 6 with S. aureus alone but not available for follow-up). 14 were left for analysis in the erythromycin group and 15 in the penicillin group.
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	Unclear risk	Compliance and baseline comparability was unclear.
Randomised?	Low risk	Quote: "The patients were assigned to receive either erythromycin or penicillin in a random, double-blind fashion by a pharmacist."
Were both inclusion and exclusion criteria specified?	Low risk	Quote: "All patients examined in the outpatient department between June and August 1986 with primarily non bullous impetigo were asked to participate in the study if they were not receiving antibiotics at the time of being seen at CGH, had not taken antibiotics during the preceding week..."

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Methods	June to August 1987; Missouri, USA; outpatients; only impetigo
Participants	2 months to 16 years M/F 55/45 S. aureus 46/100, S. pyogenes 9/100, both 25/199 PE
Interventions	A: erythromycin 40 mg/kg/day in 4 dd, 10 ds B: dicloxacillin 25 mg/kg /day in 4 dd, 10 ds
Outcomes	Outcomes of the trial 1) 5 to 7 days, cure + improved
Notes	-
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Insufficient information was available.
Allocation concealment (selection bias)	Low risk	Quote: "Participants were randomly assigned in a double-blind manner by the hospital pharmacist to receive..." Hence, participants and investigators enrolling participants could not foresee assignment.
Blinding (performance bias and detection bias) patient	Unclear risk	See above - not specified how and who was blinded.
Incomplete outcome data (attrition bias) All outcomes	High risk	41/100 participants were omitted in analysis - not specified for each group (12/100 were lost to follow up, but not stated from which group). 29 were left in the erythromycin group and 30 left in the dicloxacillin group.
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	Unclear risk	Group assignment of non-compliant participants was unclear.
Randomised?	Low risk	Quote: "Participants were randomly assigned in a double-blind manner by the hospital pharmacist to receive..."
Were both inclusion and exclusion criteria specified?	Low risk	Quote: "During the months of June, July and August, 1987, 100 children with impetigo, from whom informed consent was obtained, were consecutively enrolled in the study." Quote: "Exclusion criteria included..."

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Methods	June to August 1988; Missouri, USA; outpatients; only impetigo
Participants	3 months to 16 years M/F 49/48 S. aureus 80% PNE
Interventions	A: erythromycin 40 mg/kg/day in 3 dd, 7 days B: mupirocin ointment 2%, 3 td, 7 days
Outcomes	Outcomes of the trial 1) 4 to 7 days, cured + improved
Notes	14% bullous
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Insufficient information was available.
Allocation concealment (selection bias)	Unclear risk	This was not mentioned in the article.
Blinding (performance bias and detection bias) patient	High risk	Participant and caregiver were not blinded because they received either capsules or ointment. It is not mentioned in the article whether the outcome assessor was blinded (probably not, because the caregiver and participant were not blinded)
Incomplete outcome data (attrition bias) All outcomes	Low risk	1(/97) participant was omitted in the analysis, specified: 1/48 in the erythromycin group (lost to follow up), 0/49 in the mupirocin group.
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	Unclear risk	Compliance was not reported.
Randomised?	Low risk	Quote: "Participants were randomly assigned to receive either..."
Were both inclusion and exclusion criteria specified?	Low risk	Quote: "Children over 6 weeks of age with a clinical diagnosis of impetigo were invited to participate in the study. Exclusion criteria included..."

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Methods	Time NR; Honolulu, Hawaii; hospital outpatients; only impetigo
Participants	Average age 3.8 years Sex NR S. aureus 41/48 PNE
Interventions	3 arms: A: cephalexin 50 mg/kg/day in 3 dd + placebo ointment, 10 days B: mupirocin ointment 2%, 3 td + liquid oral placebo C: bacitracin ointment 500 units/g, 3 td + liquid oral placebo
Outcomes	Outcomes of the trial 1) 8 to 10 days, cure
Notes	-
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote: "...clinical pharmacist assigned them by a table of random numbers to one of the three treatment groups".
Allocation concealment (selection bias)	Low risk	See above and the quote: "The clinician, patients and their parents were not aware of which of the three treatment regimens they were assigned." Comment: Central allocation - participants and investigators enrolling participants could not foresee assignment.
Blinding (performance bias and detection bias) patient	Low risk	Quote: "The clinician, patients and their parents were not aware of which of the three treatment regimens they were assigned." Comment: The outcome assessor, participant, and caregiver were all blinded.
Incomplete outcome data (attrition bias) All outcomes	High risk	6/32 participants were omitted in the analysis: 0/10 in the cephalexin group, 5/12 in the mupirocin group, 1/10 in the bacitracin group (missing Imbalance for missing data).
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	Unclear risk	There was a baseline imbalance for size and type of lesion. Compliance was assessed in only 17 participants.
Randomised?	Low risk	Quote: "...clinical pharmacist assigned them by a table of random numbers to one of the three treatment groups."
Were both inclusion and exclusion criteria specified?	Low risk	Quoted from the referred article Demidovich: "Children presenting with impetigo to our clinic were eligible for the study. Exclusion criteria were..."

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Methods	December 1992 to November 1994; 25 centres, Sweden; outpatients; range of skin infections (impetigo 60/327)
Participants	Age range 3 to 80 years S. aureus 86% of 327, Streptococcus 14% of 327 Included only participants with bacteria sensitive to both drugs PE
Interventions	A: cefadroxil 40 mg/kg/day, 10 days B: flucloxacillin tablets 750 mg, 2 td, or susp 30 to 50 mg/kg/day in 2 to 3 dd, 10 days
Outcomes	Outcomes of the trial 1) 10 to 12 days, cure/improved/failed
Notes	-
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Insufficient information was available.
Allocation concealment (selection bias)	Unclear risk	The method of concealment was not described.
Blinding (performance bias and detection bias) patient	High risk	Quote: "...single blinded." Quote: "Statistical analysis was performed blinded." Comment: The participant, outcome assessor, and caregiver were probably not blinded because participants in both groups did not receive the same administrations of study drugs daily.
Incomplete outcome data (attrition bias) All outcomes	High risk	334/661 participants were missing mainly due to a lack of a bacterial culture sensitive to both drugs, and 351/661 were omitted from the primary analysis. 33 impetigo participants were included in the primary analysis. Exact reasons for not being evaluable and group assignment were not reported. 19/661 were omitted in the "ITT-analysis".
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	Unclear risk	Quote: "The randomization produced two comparable groups of patients with no differences in known prognostic factors."  Comment: There was no compliance data.
Randomised?	Low risk	Quote: "In this prospective single-blind comparative and randomized multicentre trial..."
Were both inclusion and exclusion criteria specified?	Low risk	Table 1: Inclusion and exclusion criteria for the subjects participating in the study.

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Methods	Period NR; multicentre; Europe, Latin America, Asia; range of skin infections (impetigo 42/539)
Participants	16 to 70 years (all participants) PNE
Interventions	A: clindamycin caps 150 mg, 4 td B: clindamycin caps 300 mg, 2 td C: dicloxacillin caps 250 mg, 4 td
Outcomes	Outcomes of the trial 1) 7 days, cure
Notes	-
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Insufficient information was available.
Allocation concealment (selection bias)	Unclear risk	Quote: "Drug supplies were masked." Comment: Insufficient information was available.
Blinding (performance bias and detection bias) patient	Low risk	Quote: "Drug supplies were masked." Quote: "Patients in all groups received four administrations of study drugs daily." Comment: The outcome assessor, participant, and caregiver were probably all blinded.
Incomplete outcome data (attrition bias) All outcomes	Low risk	48/588 were omitted in the analysis: 16/196 in the clindamycin caps 150 mg group, 19/198 in the clindamycin caps 300 mg group, 20/194 in the dicloxacillin caps group. Proportions of participants who did not complete the study medication and reasons were ˜ similar (table II). There were not only impetigo participants.
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	Unclear risk	Compliance data was provided (table II) and well-balanced. The distribution of baseline characteristics was not provided.
Randomised?	Low risk	Quote: "This prospective, double mask, randomized study..."
Were both inclusion and exclusion criteria specified?	Low risk	Quote: "Patients were selected based on..." Quote: "Patients were ineligible if..."

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Methods	October 1988 to October 1989; Portsmouth, Virginia, USA; outpatients; only impetigo
Participants	2 months to 12 years M/F 27/17 S. aureus 26/48 PNE
Interventions	A: erythromycin 40 mg/kg/day in 4 dd + placebo cream B: mupirocin ointment 2%, 3 td + placebo susp
Outcomes	Outcomes of the trial 1) 10 days, cured + improved
Notes	-
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote: "Using a random numbers table, the hospital pharmacist randomly assigned each patient to one of the groups."
Allocation concealment (selection bias)	Low risk	Quote: "Using a random numbers table, the hospital pharmacist randomly assigned each patient to one of the groups." Comment: central allocation - pharmacy-controlled.
Blinding (performance bias and detection bias) patient	Low risk	Quote: "The child group assignment was not known to parents or investigators." Quote: "...assigned each patient to one of two groups: orally administered erythromycin plus topically applied placebo (erythromycin group) or orally administered placebo plus topically applied mupirocin (mupirocin group)." Comment: The outcome assessor, participant, and caregiver were probably all blinded.
Incomplete outcome data (attrition bias) All outcomes	Low risk	6/54 participants were omitted in the analysis: 2/24 in the mupirocin group, 4/30 in the erythromycin group. Participants not completing the study were left out of the analysis. Reasons for not completing the study were not specified for each group. 3 were lost to follow up, 2 dropped out when misdiagnosis was suspected, and 1 was removed because of S. pyogenes pharyngitis. < 20% withdrawals and numbers were balanced.
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	High risk	Baseline characteristics were imbalanced (sex, severity), and compliance was also skewed.
Randomised?	Low risk	Quote: "Using a random numbers table, the hospital pharmacist randomly assigned each patient to one of the groups."
Were both inclusion and exclusion criteria specified?	Low risk	Quote: "Children aged 12 years and younger with the clinical diagnosis of impetigo..." Quote: "We excluded..."

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Methods	Unlear, around 2000; US, multicentre; ambulatory setting; range of skin infections (including impetigo 58/857)
Participants	12 to 93 years M/F 427/430 S.aureus 525/1685, S.pyogenes 53/1685 (including Bucko 2002b) PNE
Interventions	A: cefditoren 200 mg, 2 td, 10 days B: cefditoren 400 mg, 2 td, 10 days C: cefuroxime 250 mg, 2 td, 10 days
Outcomes	Outcomes of the trial 1) 7 to 14 days, cured or improved
Notes	-
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	This was not reported.
Allocation concealment (selection bias)	Low risk	Quote: "Study-drug containers were dispensed in numeric sequence at each investigative site as patients were enrolled to ensure random assignment."
Blinding (performance bias and detection bias) patient	Low risk	Quote: "...double-blind, double-dummy..." Quote: "Patients' evaluability and outcomes were assessed under blinded conditions". The outcome assessor, caregiver, and participant were all blinded.
Incomplete outcome data (attrition bias) All outcomes	Low risk	For only impetigo: 2/58 missing impetigo participants in total - 0/19 in the cefditoren 200 mg group, 2/21 in the cefditoren 400 mg group, 0/18 in the cefuroxime 250 mg group. Reasons for missing participants were not specified (but a small % were non-evaluable)
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	Unclear risk	There was no compliance data and no baseline imbalance.
Randomised?	Low risk	Quote: "Patients were randomized."
Were both inclusion and exclusion criteria specified?	Low risk	Quote: "Eligible patients included..." Quote: "Study exclusion criteria included..."

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Methods	Unclear, around 2000; US; multicentre; ambulatory setting; range of skin infections (including impetigo 74/828)
Participants	12 to 95 years M/F 428/400 S.aureus 525/1685, S.pyogenes 53/1685 (including Bucko 2002a) PNE
Interventions	A: Cefditoren 200 mg, 2 td, 10 days B: Cefditoren 400 mg, 2 td, 10 days C: Cefadroxil 500 mg, 2 td, 10 days
Outcomes	Outcomes of the trial 1) 7 to 14 days, cured or improved
Notes	-
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	This was not reported.
Allocation concealment (selection bias)	Low risk	Quote: "Study-drug containers were dispensed in numeric sequence at each investigative site as patients were enrolled to ensure random assignment."
Blinding (performance bias and detection bias) patient	Low risk	Quote: "...double-blind, double-dummy..." Quote: "Patients' evaluability and outcomes were assessed under blinded conditions". Comment: The outcome assessor, caregiver, and participant were all blinded.
Incomplete outcome data (attrition bias) All outcomes	Low risk	For only impetigo: 4/74 missing participants - 1/27 in the cefditoren 200 mg group, 0/25 in the cefditoren 400 mg group, 3/22 in the cefadroxil 500 mg group. Reasons for missing participants were not specified (but a small % were non-evaluable)
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	Unclear risk	There was no compliance data and no baseline imbalance.
Randomised?	Low risk	Quote: "Patients were randomized..."
Were both inclusion and exclusion criteria specified?	Low risk	Quote: "Eligible patients included..." Quote: "Study exclusion criteria included..."

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Methods	Time NR; Sweden, Germany, UK; Outpatients (Germany) and GP (UK), both (Sweden); only impetigo
Participants	3 + years M/F 131/125 S.aureus 199/256, S.pyogenes 21/256, both 36/256 PE
Interventions	A: hydrogen peroxide cream 1% (Microcid), 2 to 3 td, max 21 days B: fusidic acid cream gel 2%, 2 to 3 td, max 21 days
Outcomes	Outcomes of the trial 1) evaluation time NR, cure
Notes	-
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Quote: "...randomized (in blocks of four)." The process for selecting the blocks was not specified.
Allocation concealment (selection bias)	Unclear risk	Quote: "The tubes were put into identical paper boxes, to keep the trials blind." Comment: Insufficient information was available. The tubes may have been different.
Blinding (performance bias and detection bias) patient	Unclear risk	Quote: "The tubes were put into identical paper boxes, to keep the trials blind." There was incomplete blinding - participants were probably not blinded (see above), and blinding with regard to the outcome assessor and caregiver is unclear.
Incomplete outcome data (attrition bias) All outcomes	Low risk	135/391 participants were omitted in the analysis because they were culture negative (not specified per group); 11/156 participants in the M-group and 3/156 in the F-group were withdrawn due to deterioration of their impetigo (statistically significant), 3/156 in the F-group and 0/156 in the M-group were withdrawn due to adverse events (irritation of the skin, burning, and blistering). All participants fulfilling the prespecified requirement of bacteriologically-verified impetigo were analysed.
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	Unclear risk	There were no data on baseline comparability and compliance.
Randomised?	Low risk	Quote: "...randomized (in blocks of four)."
Were both inclusion and exclusion criteria specified?	Low risk	Quote: "...were included" Quote: "Patients were not allowed... prior to start of study..."

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Methods	1999; Turkey; hospital outpatient department; only impetigo
Participants	Age 10 to 132 months M/F 32/16 S. aureus around 70%
Interventions	A: topical mupirocin 2% 3td for 10 days B: topical terbinafine 1% 3td for 10 days
Outcomes	Outcomes of the trial 1) 10 days, cure
Notes	-
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Insufficient information was available.
Allocation concealment (selection bias)	Unclear risk	Insufficient information was available.
Blinding (performance bias and detection bias) patient	High risk	Quote: "...mupirocin group was instructed to use Bactroban 2% ointment and terbinafine group was instructed to use Lamisil 1% cream topically three times daily for ten days". The outcome assessor, caregiver, and participant were not blinded.
Incomplete outcome data (attrition bias) All outcomes	High risk	14/62 participants were not analysed: 6/31 were missing in the mupirocin group, 8/31 were missing in the terbinafine group. Quote: "At the end of the treatment, 25 participants in the mupirocin group and 23 participants in the terbinafine group were considered eligible" . > 20% missing.
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	High risk	Quote: "The group had similar features except for the time from appearance of lesions to hospital admission." There was a mean of 5.44 in the mupirocin group versus 6.78 in the terbinafine group.
Randomised?	Low risk	Quote: "...in a randomized fashion."
Were both inclusion and exclusion criteria specified?	Low risk	Quote: "...were excluded." Quote: "....children, less than 12 years old, presenting with impetigo to..."

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Methods	Time NR; France; ambulatory setting (dermatology outpatient departments); range of skin infections (including impetigo 53/334)
Participants	All participants: age > 18 years M/F 206/128 S aureus: 162/334; S pyogenes 34/334
Interventions	A: oral fusidic acid 2 x 250 mg 2 td for 7.5 days B: oral pristinamycin 2 x 500 mg 2 td for 10 days
Outcomes	Outcomes of the trial 1) 11 days, cured and improved
Notes	Outcome data for impetigo participants was provided by the author (personal communication).
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Insufficient information was available.
Allocation concealment (selection bias)	Unclear risk	Insufficient information was available.
Blinding (performance bias and detection bias) patient	Unclear risk	Quote: "Afin de garantir le double insu, chaque patient recevait le traitement dont 2.5 jours de placebo". [To ensure double blinding, each patient received a placebo for 2.5 days]. The participants were blinded, but blinding is unclear with regard to the caregiver and outcome assessor.
Incomplete outcome data (attrition bias) All outcomes	Low risk	313/334 participants were analysed (< 10% not in analysis). There is no data for impetigo participants.
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	Unclear risk	There were no compliance data and no baseline comparison.
Randomised?	Low risk	Quote: "Une etude multicentrique, prospective, randomisée..." [A randomised, prospective, multicentre study...]
Were both inclusion and exclusion criteria specified?	Low risk	Quote: "Tout patient ambulatoire, âgé de plus de 18 ans, avec une pyodermite superficielle nécessitant une antibiothérapie orale et ayant donné son consentement éclairé pouvait être inclus dans l'essai à condition de ne presenter aucun des critères d'exclusion suivants." [Most ambulatory participants, older than the 18 years old, with a superficial pyoderma requiring oral antibiotics and with given informed consent could be included in the study provided there were none of the following exclusion criteria present.]

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Methods	May to October 1987; Negev region, Israel; outpatients; only impetigo
Participants	6 months to 9 years Sex NR S. aureus 37/51, S. pyogenes 14/51 PE
Interventions	A: amoxicillin trihydrate syrup 40 mg/kg/day, in 3 dd, 10 days B: amoxicillin/clavulanic acid syrup 40 + 10 mg/kg/day, in 3 dd, 10 days
Outcomes	Outcomes of the trial 1) 5 days, cure + improved
Notes	There was missing data from the first follow-up measurement for 4/26 participants in the amoxicillin trihydrate syrup group and 3/25 participants in the amoxicillin/clavulanic acid syrup group.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Insufficient information was available.
Allocation concealment (selection bias)	Unclear risk	Insufficient information was available.
Blinding (performance bias and detection bias) patient	Unclear risk	Quote: "...in a double-blind fashion". It is unclear whether the outcome assessor, participant, or caregiver were blinded.
Incomplete outcome data (attrition bias) All outcomes	Low risk	7/52 (< 20%) participants were omitted in the analysis after 5 days.
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	High risk	There was a baseline imbalance for lymphadenopathy > 20%. There were no compliance data.
Randomised?	Low risk	Quote: "After obtaining the cultures, patients were randomized to..."
Were both inclusion and exclusion criteria specified?	High risk	Quote: "We included..." Exclusion criteria was not mentioned.

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Methods	July 1989 to October 1990; Negev region, Israel; outpatients; only impetigo (bullous and non-bullous)
Participants	< 16 years M/F 56/46 S. aureus 90/102, streptococci 1/3 of participants PNE
Interventions	A: erythromycin susp 50 mg/kg/day 3 td + placebo ointment, 7 days B: mupirocin ointment 2% 3 td + oral placebo susp, 7 days
Outcomes	Outcomes of the trial 1) 7 days, failed
Notes	-
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Insufficient information was available.
Allocation concealment (selection bias)	Low risk	Quote: "The randomized code was prepared by Beecham Pharmaceutical and was not known to the investigators until after the raw data were tabulated."
Blinding (performance bias and detection bias) patient	Low risk	Quote: "The randomized code was prepared by Beecham Pharmaceutical and was not known to the investigators until after the raw data were tabulated." The erythromycin group received a placebo ointment and the mupirocin group received an oral placebo suspension. The outcome assessor, caregiver, and participant were probably all blinded.
Incomplete outcome data (attrition bias) All outcomes	Low risk	13/102 participants were omitted in the analysis: 8/51 in the erythromycin group (1 due to side-effects, 7 due to refusal to continue treatment or to return for the follow-up visit), 5/51 missing in the mupirocin group (all due to refusal to continue treatment or to return for the follow-up visit).
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	Unclear risk	There were age and sex differences at baseline (table 1), although they were not significant. There were no compliance data.
Randomised?	Low risk	Quote: "...were randomized into two groups."
Were both inclusion and exclusion criteria specified?	Low risk	Quote: "Infants... were enrolled." Quote: "Excluded groups were..."

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Methods	1987 to 1991; Belgium, France, FRG, Netherlands, Norway, UK; setting unclear; range of skin infections (including impetigo 69/308)
Participants	16 to 80 years All participants: S. aureus 195/308, streptococci 59/308 PNE
Interventions	A: azithromycin 250 mg twice (day 1),once daily (day 2 to 5), 5 days B: erythromycin 500 mg 4 td, 7 days
Outcomes	Outcomes of the trial 1) 11 to 16 days, cured
Notes	-
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote: "Patients were allocated to treatment with azithromycin or erythromycin in a 1:1 ratio using a randomization list."
Allocation concealment (selection bias)	Unclear risk	See above - it is unclear whether participants and investigators enrolling participants could foresee assignment.
Blinding (performance bias and detection bias) patient	High risk	Participants in both groups did not receive the same administrations of study drugs daily. The outcome assessor was likely to also be the caregiver, so probably all 3 were not blinded.
Incomplete outcome data (attrition bias) All outcomes	Low risk	The number of impetigo participants not included in analysis was small and well-balanced (1 vs 2).
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	Unclear risk	There were no compliance data. Baseline characteristics were well-balanced.
Randomised?	Low risk	Quote: "Patients were allocated to treatment with azithromycin or erythromycin in a 1:1 ratio using a randomization list."
Were both inclusion and exclusion criteria specified?	Low risk	Quote: "In order to be included..." Quote: "Exclusion criteria were..."

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Methods	1987 to 1989; Belgium, Germany, Ireland, UK; setting unclear; range of skin infections (including impetigo 17/323)
Participants	Adults 17 to 90 years All participants: S aureus 158/323, streptococci 41/323 PNE
Interventions	A: azithromycin 250 mg twice (day 1),once daily (day 2 to 5), 5 days B: cloxacillin 500 mg, 4 td, 7 days
Outcomes	Outcomes of the trial 1) 11 to 16 days, cured/improved/failed
Notes	-
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote: "Using a presupplied randomization list patients were allocated to receive azithromycin or cloxacillin in the ratio of 2:1."
Allocation concealment (selection bias)	Unclear risk	See above - it is unclear whether participants and investigators enrolling participants could foresee assignment.
Blinding (performance bias and detection bias) patient	High risk	Participants in both groups did not receive the same administrations of study drugs daily. The outcome assessor, caregiver, and participant were probably not blinded.
Incomplete outcome data (attrition bias) All outcomes	Low risk	Only 1 impetigo participant was not in the analysis.
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	Unclear risk	There were no compliance data. Baseline characteristics were comparable.
Randomised?	Low risk	Quote: "Using a presupplied randomization list patients were allocated to receive azithromycin or cloxacillin in the ratio of 2:1."
Were both inclusion and exclusion criteria specified?	Low risk	Quote: "In order to be included..." Quote: "Exclusion criteria were..."

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Methods	Time NR; Honolulu, Hawaii; outpatients; only impetigo
Participants	5 months to 15 years, average 3 years S. aureus 45/73, GABHS 6/73, both 14/73 PNE
Interventions	A: penicillin V 40 to 50 mg/kg/day in 3 dd, 10 days B: cephalexin 40 to 50 mg/kg/day in 3 dd, 10 days C: erythromycin 30 to 40 mg/kg/day in 3 dd, 10 days
Outcomes	Outcomes of the trial 1) 8 to 10 days, failed
Notes	-
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Insufficient information was available.
Allocation concealment (selection bias)	Low risk	Quote: "The pharmacist randomly assigned them to one of three treatment regimens." Central allocation - participants could not foresee assignment.
Blinding (performance bias and detection bias) patient	Unclear risk	Quote: "Patients were reevaluated...by one of the authors, both of whom were blinded to the treatment each child was receiving." Comment: Participants were probably not blinded. The caregiver and outcome assessor were probably blinded.
Incomplete outcome data (attrition bias) All outcomes	Low risk	2/75 participants were omitted in the analysis: 2 participants were lost to follow up (not further specified).
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	Unclear risk	Quote: "There was not a significant difference in disease severity among treatment groups." Compliance in both groups was comparable, but low.
Randomised?	Low risk	Quote: "The pharmacist randomly assigned them to one of three treatment regimens."
Were both inclusion and exclusion criteria specified?	Low risk	Quote: "Children presenting with impetigo to our pediatric clinic were eligible for the study. Exclusion criteria were..."

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Methods	1980 summer/fall; Alabama, USA; outpatients; only impetigo (bullous impetigo 57/70)
Participants	Average age 3.2 years MF 41/37 S. aureus: 64/70 PNE
Interventions	A: cephalexin 50 mg/kg/day in 2 dd (> 20 kg: 500 mg 2 td) B: dicloxacillin 15 mg/kg/day in 4 dd (> 40 kg: 125 mg 4 td)
Outcomes	Outcomes of the trial 1) Prompt cure
Notes	-
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote: "Patients were randomly assigned, according to a standard table, to receive..." (Referring to a standard table.)
Allocation concealment (selection bias)	Unclear risk	See above - it is unclear whether participants and investigators enrolling participants could foresee assignment.
Blinding (performance bias and detection bias) patient	High risk	Participants in both groups did not receive the same administrations of study drugs daily. The outcome assessor, caregiver, and participant were probably not blinded.
Incomplete outcome data (attrition bias) All outcomes	Low risk	8/78 participants were omitted in the analysis: 5 vs 3 participants failed to return or, with a negative culture, were not included in the analysis (< 20% and balanced).
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	Unclear risk	Quote: "Preference was given to patients with skin infections typical of staphylococcal bullous impetigo." Comment: Furthermore, there were no baseline differences, and compliance was not reported.
Randomised?	Low risk	Quote: "Patients were randomly assigned, according to a standard table, to receive..."
Were both inclusion and exclusion criteria specified?	Low risk	Quote: "The criterion for enrolment was..." Quote: "...were excluded."

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Methods	Time NR; Toronto, Canada; setting unclear; range of skin infections (including impetigo 36/149)
Participants	Average age 22 years M/F 81/68 Bacterial culture results unclear PNE
Interventions	A: mupirocin ointment 2%, 3 td, 7 days B: erythromycin 250 mg, 4 td, 7 days C: cloxacillin 250 mg, 4 td, 7 days
Outcomes	Outcomes of the trial 1) 7 days, cure/improved/failure. Clocacillin: no participants with impetigo allocated
Notes	2 cases of secondary impetigo, both in the mupirocin group, were excluded from the results presented here.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Insufficient information about the sequence generation process was available, and there was unexpected distribution (78 vs 50 vs 20).
Allocation concealment (selection bias)	Unclear risk	Quote: "...were randomized into two treatment groups by each investigator." Comment: It is unclear whether participants and investigators enrolling participants could foresee assignment.
Blinding (performance bias and detection bias) patient	Unclear risk	Quote: "...single-blind". Comment: It is not clear who was blinded and how this was done. Also, participants in both groups did not receive the same administrations of study drugs daily. Participants were probably not blinded. The blinding of outcome assessor and caregiver is unclear.
Incomplete outcome data (attrition bias) All outcomes	Low risk	1 (/149) participant was omitted in the analysis: 1/79 in the mupirocin group due to an infected cyst (not included in analysis), 0/50 in the erythromycin group, 0/20 in the cloxacillin group.
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	Unclear risk	Compliance was not reported. There was a large age difference between groups (mean 22 vs 31 years), unknown for impetigo participants.
Randomised?	Low risk	Quote: "In each section of the study, patients with primary or secondary skin infections were randomized into two treatment groups."
Were both inclusion and exclusion criteria specified?	Low risk	Quote: "Patients with primary and secondary skin infections that were severe enough were included in three parallel-study groups." Quote: "Patient who did not..."

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Methods	October to November 1983; Puerto Rico; outpatients; only impetigo
Participants	7 months to 13 years M/F 13/25 Mainly S.aureus PE
Interventions	A: mupirocin ointment 2%, 3 td, 7 to 9 days B: vehicle control, 3 td, 7 to 9 days
Outcomes	Outcomes of the trial 1) 8 days, cure/improved/failure 1 participant with ecthyma was excluded in each group.
Notes	-
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote: "Patients were randomized between the two treatment groups by a computer-generated set of random numbers in blocks of five per group."
Allocation concealment (selection bias)	Unclear risk	Insufficient information was available.
Blinding (performance bias and detection bias) patient	Low risk	Quote: "...double-blind, vehicle-controlled." Also, participants in both groups received the same administrations of study drugs daily. The outcome assessor, caregiver, and participant were probably all blinded.
Incomplete outcome data (attrition bias) All outcomes	High risk	14/52 participants were omitted in the analysis: 8/26 in the mupirocin group (5 were "unavailable for follow-up", 3 for several reasons (specified)), 6/26 in the vehicle group (2 were "unavailable for follow-up", 3 for several reasons (specified)). There were more than 20% withdrawals and dropouts.
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	Unclear risk	There was no baseline imbalance. Compliance was not reported.
Randomised?	Low risk	Quote: "Patients were randomized between the two treatment groups by a computer-generated set of random numbers in blocks of five per group."
Were both inclusion and exclusion criteria specified?	Low risk	Quote: "...were admitted to the study." Quote: "Patients were excluded if..."

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Methods	Time NR; Milwaukee, Wisconsin, USA; outpatients; only impetigo
Participants	3 months to 14 years, average 4.3 years S.aureus 33%; GABHS 12%; both 41% Exclusions: NR
Interventions	A: mupirocin (dose NR) B: erythromycin (dose NR)
Outcomes	Outcomes of the trial 1) Time of evaluation NR, failure
Notes	-
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Insufficient information was available.
Allocation concealment (selection bias)	Unclear risk	It is unclear whether participants and investigators enrolling participants could foresee assignment.
Blinding (performance bias and detection bias) patient	High risk	Oral versus topical treatment. The outcome assessor, caregiver, and participant were probably not blinded.
Incomplete outcome data (attrition bias) All outcomes	Low risk	9/48 participants were omitted in the analysis: 4/25 in the mupirocin group (3 due to "fail to return for follow-up", 1 reason not mentioned), 5/23 in the erythromycin group (3 due to "fail to return for follow-up", 2 reasons not mentioned).
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	Unclear risk	There were no baseline characteristics per group. There were no compliance data.
Randomised?	Low risk	Quote: "...randomized."
Were both inclusion and exclusion criteria specified?	High risk	This was not mentioned in the article.

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Methods	Time NR; Lebanon; outpatients; probably all impetigo ('superificial pyogenic skin infection')
Participants	21 days to 60 years of age M/F unknown S. aureus 61%, S. pyogenes 30%
Interventions	A: gentamycin cream 1% 3 td, duration unknown B: neomycin ointment 0.5% 3 td, duration unknown
Outcomes	Outcomes of the trial 1) Cured, improved after 7 days
Notes	-
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Insufficient information was provided.
Allocation concealment (selection bias)	Unclear risk	This was not reported.
Blinding (performance bias and detection bias) patient	Unclear risk	This was not reported.
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	11/139 participants were lost to follow up (it was not stated in which group).
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	Unclear risk	There was an unexplained imbalance of group size (88 vs. 44). There were no compliance data. There was no baseline comparison.
Randomised?	Low risk	Quote: "The persons included in this study were divided into two groups at random."
Were both inclusion and exclusion criteria specified?	High risk	Inclusion and exclusion criteria was not specified.

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Methods	2002 to 2003; Mali; hospital outpatients; only impetigo
Participants	Inclusion > 1 year of age Mean age 8.5 years M/F 74/58 No bacteriological investigation
Interventions	A: oral amoxicillin 50 mg/kg/day + topical 10% povidone iodine for 7 days B: oral erythromycin 30 mg/kg/day + topical 10% povidone iodine for 7 days
Outcomes	Outcomes of the trial 1) Proportion cured + improved after 7 days
Notes	-
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote: "...using a table of random numbers". Comment: This was an adequate method.
Allocation concealment (selection bias)	Unclear risk	Insufficient information was available.
Blinding (performance bias and detection bias) patient	High risk	Quote: "....an open randomized trial." Quote: "Patients and investigators were not blinded." The outcome assessor, participant, and caregiver were not blinded.
Incomplete outcome data (attrition bias) All outcomes	Low risk	3/132 participants were not analysed: 2/66 in the amoxicillin group (2 lost to follow up on the 7th day), 1/66 in the erythromycin group (1 lost to follow up on the 7th day).
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	Unclear risk	There was no baseline comparison. There were no compliance data.
Randomised?	Low risk	Quote: "...an open randomized trial."
Were both inclusion and exclusion criteria specified?	Low risk	Quote: "Patients aged more than 1 year old... were considered for inclusion." Quote: "The following cases were excluded..."

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Methods	Time NR; Japan; outpatients; range of skin infections (including impetigo 10/204)
Participants	Age 16 to 84 years M/F 120/84 (all participants)
Interventions	A: enoxacin 500 mg 3 td B: cephalexin 500 mg 2 td (double dummy)
Outcomes	Outcomes of the trial 1) After .... cured/improved
Notes	Secondary impetigo- it only says impetigo above
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	This was not mentioned in the abstract.
Allocation concealment (selection bias)	Unclear risk	This was not mentioned in the abstract.
Blinding (performance bias and detection bias) patient	Unclear risk	Quote: "...a double-blind." They used placebo capsules (see Figure 1 Dosage schedule). Participants were probably blinded. It is not clear how, and if, the caregiver and outcome assessor were blinded.
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	22/226 participants were omitted in the analysis: 14/115 in the enoxacin group (2 due to exclusion (1 overlap administration and 1 antibiotics before treatment), 12 dropped out (11 shortage of duration, 1 no successive visit)), 8/111 in the cephalexin group (all dropped out (7 shortage of duration, 1 no successive visit). < 20% but not specified for impetigo participants.
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	Unclear risk	There was no baseline imbalance (table 4), and compliance was not reported.
Randomised?	Unclear risk	This was not mentioned in the abstract.
Were both inclusion and exclusion criteria specified?	Unclear risk	This was not mentioned in the abstract.

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Methods	Time NR; Quebec, Canada; outpatients; range of skin infections (including impetigo 19/70)
Participants	Age NR S. aureus 41/70; Streptococci 22/70 (all participants) PE
Interventions	A: mupirocin ointment 2%, 3 td, 7 days B: fusidic acid cream 2%, 3 td, 7 days
Outcomes	Outcomes of the trial 1) 7 days, cure/improved/failure
Notes	-
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Insufficient information was available.
Allocation concealment (selection bias)	Unclear risk	Insufficient information was available.
Blinding (performance bias and detection bias) patient	Unclear risk	The abstract reported the study was double-blind, but it is not explained in the article. There is unclear blinding of the outcome assessor, caregiver, and participant.
Incomplete outcome data (attrition bias) All outcomes	Low risk	1 (/70) participant was omitted in the clinical analysis: 0/35 in the fusidic acid group, 1/35 in the mupirocin group. Participants were not examined if pre-treatment cultures were negative or if post-treatment evaluation was not possible.
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	Unclear risk	There was no baseline imbalance, and compliance was not reported.
Randomised?	Low risk	Quote: "Patients were randomly divided into two treatment groups."
Were both inclusion and exclusion criteria specified?	Low risk	Quote: "Patients who... were excluded from the trial." Quote: "...in 70 patients who came to the dermatologic clinic with primary and secondary skin infections of sufficient severity to require antibiotic therapy."

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Methods	Time NR; Dallas, Texas, USA; outpatients; only impetigo
Participants	8 months to 8 years, average 3.1 years Sex NR S.aureus 78%, GABHS 64%, both 50% Part excluded: unclear
Interventions	A: penicillin G 30 mg/kg/day in 4 dd, duration NR B: cefadroxil 45 mg/kg/day in 3 dd, duration NR
Outcomes	Outcomes of the trial 1) 8 days, cured + improved
Notes	-
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Insufficient information was available.
Allocation concealment (selection bias)	Unclear risk	It is unclear whether participants and investigators enrolling participants could foresee assignment.
Blinding (performance bias and detection bias) patient	High risk	Participants in both groups received different administrations of study drugs daily. The outcome assessor, caregiver, and participant were probably not blinded.
Incomplete outcome data (attrition bias) All outcomes	High risk	21/71 participants were omitted in the analysis due to failure to return for both follow-up examinations. There were more than 20% withdrawals; this was not further specified for each group.
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	Unclear risk	Quote: "Groups were comparable with regard to age, sex, race and extent of skin lesion." Compliance was unclear.
Randomised?	Low risk	Quote: "Infants and children with impetigo were assigned treatment randomly."
Were both inclusion and exclusion criteria specified?	High risk	Quote: "Infants and children with impetigo were assigned..." No exclusion criteria were specified.

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Methods	2005; US; hospital outpatients; skin infections (including impetigo 16/391)
Participants	All diagnoses: 13 to 93 years M/F 206/185 S. aureus 44%; S. pyogenes 2%
Interventions	A: oral cefdinir 300 mg 2 td 10 days B: cephalexin 200 mg 4 td 10 days
Outcomes	Outcomes of the trial 1) Proportion cured + improved after 17 to 24 days
Notes	-
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote: "A computer-generated randomization schedule in a 1:1 ratio was used." Quote: "Study drug containers were dispensed in increasing numerical sequence at each investigative site."
Allocation concealment (selection bias)	Unclear risk	Quote: "To maintain investigator blinding, the study drug was dispensed by an unblinded third person who did not participate in the assessments of clinical response." Comment: It is not clear whether this person was involved in participant contacts.
Blinding (performance bias and detection bias) patient	Unclear risk	Quote: "...investigator-blinded." Quote: "To maintain investigator blinding, the study drug was dispensed by an unblinded third person who did not participate in the assessments of clinical response. Furthermore, the participant was instructed not to disclose any details about the study drug (...) to the investigator." The outcome assessor and caregiver were blinded. The participants were not blinded.
Incomplete outcome data (attrition bias) All outcomes	Low risk	There were 0/16 missing impetigo participants: 0/4 in the cefdinir group, 0/12 in the cephalexin group. All 391 who took at least 1 dose of the study drug were analysed.
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	Unclear risk	There were no compliance data. There was no baseline comparison.
Randomised?	Low risk	Quote: "A computer-generated randomization schedule..."
Were both inclusion and exclusion criteria specified?	Low risk	Quote: "...were enrolled" Quote: "Study exclusion criteria included..."

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Methods	Time NR; Cleveland, Ohio, USA; outpatients; only impetigo
Participants	5 months to 13 years, average 3.8 M/F 31/31 S.aureus 49/62, Streptococci 4/62, both 9/62 PE: NR
Interventions	A: mupirocin ointment 2%, 3 td, 8 days B: erythromycin 40 mg/kg/day in 4 dd, 8 days
Outcomes	Outcomes of the trial 1) 8 days, cured/failed
Notes	-
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Insufficient information was available.
Allocation concealment (selection bias)	Unclear risk	It is unclear whether participants and investigators enrolling participants could foresee assignment.
Blinding (performance bias and detection bias) patient	High risk	Topical versus oral treatment. The outcome assessor, caregiver, and participant were probably not blinded.
Incomplete outcome data (attrition bias) All outcomes	Low risk	10/62 participants were lost in total: 5/30 in the mupirocin group (all lost to follow up), 5/32 in the erythromycin group (all lost to follow up).
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	Unclear risk	The severity of impetigo was not compared between the 2 groups. There was a difference in age (range vs mean). Compliance was not reported.
Randomised?	Low risk	Quote: "Enrolled children were randomly assigned to groups that..."
Were both inclusion and exclusion criteria specified?	Low risk	Quote: "Children 3 months of age and older were seen at...were eligible for our study." Quote: "Children were excluded if..."

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Methods	July to September 1980; Florida, USA; outpatients; only impetigo (bullous and non-bullous).
Participants	6 months to 12 years Participants were excluded if no S. aureus was present
Interventions	A: penicillin V potassium 50 mg/kg/day, in 4 dd, 10 days B: cloxacillin sodium 50 mg/kg/day, in 4 dd, 10 days
Outcomes	Outcomes of the trial 1) 10 days: cured + improved
Notes	-
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Insufficient information was available.
Allocation concealment (selection bias)	Unclear risk	Quote: "...on a randomized schedule at the following dosages". It is unclear whether participants and investigators enrolling participants could foresee assignment.
Blinding (performance bias and detection bias) patient	Unclear risk	Quote: "The clinical examiners were blinded to the antibiotic that the patients received until the study was concluded." Quote: "...double-blind schedule." It is not clear how patients were blinded, and the participant was likely to be influenced in the case of lack of blinding. The outcome assessor and caregiver were blinded.
Incomplete outcome data (attrition bias) All outcomes	High risk	24/101 participants were lost due to no S. aureus growth, 10 were lost in failure to return to the clinic (reasons for not attending follow-up visit were not stated). The imbalance in participants was not evaluated.
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	Unclear risk	There was no baseline severity comparison between groups. Participant compliance data was computed and presented no significant alterations in therapeutic outcome.
Randomised?	Low risk	Quote: "...on a randomized schedule at the following dosages..."
Were both inclusion and exclusion criteria specified?	Low risk	Quote: "...could be enrolled on the study if the following criteria were met..." Quote: "There were no prior histories of allergic phenomena."

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Methods	Time NR; Edinburgh, UK; general practice; range of skin infections (including impetigo 39/107)
Participants	Average age 18.7 (all participants) S. aureus 90/129, streptococci 32/129 (all participants) PNE
Interventions	A: mupirocin ointment 2%, once daily, until cleared B: placebo cream, once daily, until cleared
Outcomes	Outcomes of the trial 1) Time of evaluation NR, cure/improved/failure
Notes	-
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Quote: "Patients were allocated a trial number in the consecutive order of their entry in the study. The study was performed under double blind conditions. Medication appropriate to the trial number, either mupirocin or placebo ointment, was dispensed according to a pre-determined randomization which ensured that in each group of four patients, two received treatment with mupirocin and two with placebo ointment." The process for selecting the blocks was not specified.
Allocation concealment (selection bias)	Unclear risk	Insufficient information was available.
Blinding (performance bias and detection bias) patient	Unclear risk	Quote: "The study was performed under double-blind conditions." It is unclear whether, and how, the outcome assessor, caregiver, and participant were blinded.
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	14/107 participants were omitted in the analysis: 10/54 in the mupirocin group (they were classified as clinically unassessable, 7 did not return for final assessment (5 were traced later and found to have clinically improved), 3 developed other diseases requiring systemic treatment), 4/53 in the placebo group (3 did not return for final assessment (2 of whom were later found to have improved and one worsened and sought alternative treatment), 1 developed other disease requiring systemic treatment). < 20%, 3 vs 1 impetigo participant not evaluable.
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	Unclear risk	Quote: "...well matched". There was no compliance data.
Randomised?	Low risk	Quote: "...according to a pre-determined randomization."
Were both inclusion and exclusion criteria specified?	Low risk	Quote: "Patients with acute primary skin infections...who had not received topical or systemic antibiotics during the preceding 3 days were entered in the study."

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Methods	Time NR; Montreal, Quebec, Canada; outpatients; range of skin infections (including impetigo 15/60)
Participants	Age/sex NR S. aureus approx 50% PE: NR
Interventions	A: mupirocin ointment 2%, 3 td, 7 days B: erythromycin 250 mg, 4 td, 7 days
Outcomes	Outcomes of the trial 1) 7 days, cure/improved/failure
Notes	-
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Insufficient information was available.
Allocation concealment (selection bias)	Unclear risk	Quote: "...were randomly divided into two treatment groups." It is unclear whether participants and investigators enrolling participants could foresee assignment.
Blinding (performance bias and detection bias) patient	High risk	Topical versus oral treatment. The outcome assessor, caregiver, and participant were probably not blinded.
Incomplete outcome data (attrition bias) All outcomes	Low risk	0/60 participants were omitted in the analysis: 0/30 in the mupirocin group, 0/30 in the erythromycin group. 1 participant in the mupirocin group discontinued therapy due to intolerable side-effects. All impetigo participants were included in the analysis.
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	Unclear risk	There was no baseline data. There were no compliance data.
Randomised?	Low risk	Quote: "...were randomly divided into two treatment groups."
Were both inclusion and exclusion criteria specified?	High risk	Quote: "Sixty patients with primary and secondary skin infections were randomly divided." No exclusion criteria was specified.

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Methods	Summer 1986; Birmingham, Alabama, US; outpatients child hospital; only impetigo
Participants	1 to 18 years Sex NR S. aureus 35%, GABHS 12%, both 54% PE: NR
Interventions	A: cefadroxil 30 mg/kg/day, max 1 g, in 1 dd, 10 days B: cephalexin 30 mg/kg/day, max 1 g, in 2 dd, 10 days
Outcomes	Outcomes of the trial 1) 14 days, cured
Notes	-
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Insufficient information was available.
Allocation concealment (selection bias)	Unclear risk	Quote: "Patients were randomly assigned to receive either..." It is unclear whether participants and investigators enrolling patients could foresee assignment.
Blinding (performance bias and detection bias) patient	High risk	Participants in both groups received different administrations of study drugs daily. The outcome assessor, caregiver, and participant were probably not blinded.
Incomplete outcome data (attrition bias) All outcomes	Low risk	13/101 participants were omitted in the analysis in total: 4/55 in the cefadroxil group (1 failed to keep all of the appointments, 3 participants failed to take medications as prescribed), 9/54 in the cephalexin group (3 with negative cultures, 4 failed to keep all of the appointments, 2 participants failed to take medications as prescribed). < 20% and reasons described.
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	Unclear risk	There was baseline data. Compliance was good in both groups.
Randomised?	Low risk	Quote: "Patients were randomly assigned to receive either..."
Were both inclusion and exclusion criteria specified?	Low risk	Quote: "...who had a clinical diagnosis of pyoderma were enrolled." Quote: "Children were excluded if..."

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Methods	Summer 1976; Tokyo, Japan; hospital outpatient clinic; bullous impetigo
Participants	0 to 10 years M/F 26/34 No bacterial investigations All participants evaluable
Interventions	A: topical Eksalbe simplex (ointment containing killed escherichia, staphylococcus, streptococcus, and pseudomonas) applied once daily under plaster or 3 times daily without plaster B: placebo
Outcomes	Outcomes of the trial 1) Cured/improved after 4 days
Notes	Data extraction and risk of bias assessment done by Testuri Matsumura.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	This was not reported.
Allocation concealment (selection bias)	Low risk	Allocation was concealed (assessed by Tetsuru Matsumura).
Blinding (performance bias and detection bias) patient	Low risk	The participant, outcome assessor, and caregiver were blinded.
Incomplete outcome data (attrition bias) All outcomes	Low risk	2/40 participants were dropouts and excluded from the analysis.
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	Unclear risk	There were no compliance data.
Randomised?	Low risk	This trial was randomised (assessed by Tetsuru Matsumura).
Were both inclusion and exclusion criteria specified?	High risk	Exclusion criteria were not specified.

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Methods	Time NR; Cleveland, Ohio, USA; outpatients child clinic; range of skin infections (including impetigo 32/42)
Participants	6 months to 12 years, average 4.8 years S. aureus 33/36, S. pyogenes 8/36 PNE
Interventions	A: amoxicillin/clavulanic (125/30) acid, dose equivalent to 20 mg amoxicillin/kg/day in 3 dd, 10 days B: cefaclor 20 mg/kg/day in 3 dd
Outcomes	Outcomes of the trial 1) 10 days, cured/failed
Notes	-
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Insufficient information was available.
Allocation concealment (selection bias)	Low risk	Quote: "Prescription were filled by the hospital pharmacist using double-blind labels." Personnel or participants could, probably, not foresee assignment.
Blinding (performance bias and detection bias) patient	Low risk	Quote: "Prescription were filled by the hospital pharmacist using double-blind labels." The outcome assessor, caregiver, and participant were probably all blinded.
Incomplete outcome data (attrition bias) All outcomes	Low risk	0/43 participants were omitted in the analysis: 0/21 in the amoxicillin/clavulanic acid group, 0/22 in the cefaclor group.
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	Low risk	Quote: "The two treatment groups were generally comparable." Compliance was good in 75% of participants.
Randomised?	Low risk	Quote: "Children were randomly assigned to one of the two treatment regimens."
Were both inclusion and exclusion criteria specified?	Low risk	Quote: "Children 6 months to...were eligible for inclusion in the study." Quote: "Exclusion criteria included..."

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Methods	Time NR; multicentre, Wessex, UK; general practice; range of skin infections (including impetigo 43/119)
Participants	2.5 years to 83 years, median 14 to 16 years M/F 23/20 S. aureus 16/34, S. pyogenes 5/34 PNE
Interventions	A: 1% hydrocortisone + 0.5% potassium hydroxyquinoline sulphate cream, 2 td, 14 days B: 1% hydrocortisone + 2% miconazole nitrate cream, 2 td, 14 days
Outcomes	Outcomes of the trial 7 days, cured/improved
Notes	-
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Insufficient information was available.
Allocation concealment (selection bias)	Unclear risk	Quote: "The trial was double-blind, patients being allocated at random to receive..." Quote: "The randomization was balanced for each centre, with separate randomizations for each of the two indications." It is unclear whether participants and investigators enrolling participants could foresee assignment.
Blinding (performance bias and detection bias) patient	Low risk	Quote: "Unmarked plain tubes of the marketed formulation of each product were packed in plain sealed cartons, neither doctors nor patients being aware of the identity of the products until the end of the study." Comment: The outcome assessor, caregiver, and participant were probably blinded.
Incomplete outcome data (attrition bias) All outcomes	Low risk	0/119 participants were omitted in the analysis: 0/65 in group 1, 0/54 in group 2.
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	Unclear risk	Details of age, duration of condition, and total symptom severity score were recorded and were similar. There were no compliance data.
Randomised?	Low risk	Quote: "The trial was double-blind, patients being allocated at random to receive..."
Were both inclusion and exclusion criteria specified?	Low risk	Quote: "...who presented... were included in the study." Exclusion criteria was not specified.

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Methods	Time NR; Bristol, UK; general practice; only impetigo
Participants	Average age 11 years (mupirocin), 17 years (neomycin) M/F 2/1 S. aureus 23/34, S. pyogenes 10/34 PNE
Interventions	A: mupirocin ointment 2%, 2 td, 10 to 11 days B: neomycin ointment 1%, 2 td, 10 to 11 days
Outcomes	Outcomes of the trial 1) Time of evaluation NR, cure/improved/failure
Notes	-
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Quote: "Allocation of treatment was on a randomized basis. In each consecutive group of four patients, two received Bactroban ointment and two received neomycin." Comment: They probably used blocked randomisation, but the process of selecting the blocks was not specified.
Allocation concealment (selection bias)	Unclear risk	It is unclear whether participants and investigators enrolling participants could foresee assignment.
Blinding (performance bias and detection bias) patient	Unclear risk	Quote: "The 15-g tubes differed only in their code numbers and in both cases the content was a white ointment." It is unclear how investigators were blinded. The caregiver and participant were probably blinded.
Incomplete outcome data (attrition bias) All outcomes	Low risk	9/41 participants were omitted in the analysis: 8 were excluded due to a "stated diagnosis other than uncomplicated impetigo" (not stated which group), 1 missing from the mupirocin group due to "failure to attend to follow-up".
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	Unclear risk	There was baseline imbalance for age (mean 11 vs 17 years). There were no compliance data.
Randomised?	Low risk	Quote: "Allocation of treatment was on a randomized basis."
Were both inclusion and exclusion criteria specified?	Low risk	Quote: "Patients were selected from those presenting with typical impetigo." Quote: "Patients were excluded if..."

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Methods	Time NR; multicentre USA (Southern States); admitted + outpatients; range of skin infections (including impetigo 18/179)
Participants	Age > 16, 211/154 (all participants) S. aureus 152/179, S. pyogenes 29/179 (all participants) PE
Interventions	A: azithromycin 500 mg day 1, 250 mg, day 2 to 5, 5 days B: cephalexin 500 mg twice daily, 10 days
Outcomes	Outcomes of the trial 1) 11 days, cured/improved
Notes	-
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Insufficient information was available.
Allocation concealment (selection bias)	Unclear risk	Insufficient information was available.
Blinding (performance bias and detection bias) patient	Unclear risk	Quote: "In this double blind..." Quote: "Using a double-dummy technique, each patient received placebo capsules which were visually identical to the active drugs." Comment: The caregiver and participant were probably blinded. There was unclear blinding of the outcome assessor.
Incomplete outcome data (attrition bias) All outcomes	High risk	187/366 participants were omitted in the analysis: 99/182 in the azithromycin group (58 due to "no baseline pathogen", 15 due to "no end of therapy assessment", 15 due to "the presence of a resistant pathogen" (only main reasons mentioned)), 88/184 in the cephalexin group (55 due to "no baseline pathogen", 6 due to "no end of therapy assessment", 6 due to "the presence of a resistant pathogen" (main reasons mentioned)). > 20% no end of therapy assessment (not specified for impetigo only).
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	Unclear risk	There was a baseline comparison for sex, race, and primary diagnosis. There was no baseline imbalance. There were no compliance data.
Randomised?	Low risk	Quote: "Patients were randomly assigned in a double-blind fashion to one of the two treatment groups."
Were both inclusion and exclusion criteria specified?	Low risk	Quote: "Patients were entered in the study based on..." Quote: "...were excluded by the protocol."

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Methods	February 1999 to November 2000; Rotterdam, Netherlands; general practice; only impetigo
Participants	< 12, average age 5.0 years M/F 98/62 S. aureus 127/160, S. pyogenes 5/160, both 8/160, none 20/160 PNE
Interventions	A: fusidic acid cream 2%, 3 td + povidone iodine shampoo, 2 td B: placebo cream, 3 td + povidone iodine shampoo, 2 td
Outcomes	Outcomes of the trial 1) 7 days, cure
Notes	-
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote: "An independent statistician provided a computer-generated list of random set numbers in permuted blocks of six. The hospital pharmacist packed the study medication in identical blank tubes with a number according to the randomisation list."
Allocation concealment (selection bias)	Low risk	See above - probably done: central allocation.
Blinding (performance bias and detection bias) patient	Low risk	Quote: "Unblinding took place after the primary statistical analysis had been done." Quote: "....research nurse was unaware of treatment allocation." Quote: "...placebo cream did not differ." Quote: "Unblinding took place after the primary statistical analysis had been done." Comment: The outcome assessor, caregiver, and participant were probably all blinded.
Incomplete outcome data (attrition bias) All outcomes	Low risk	4/160 participants were omitted in the analysis (after 1 week): 2/78 in the fusidic acid cream group (both did not want to follow up), 2/82 in the placebo cream group (both did not want to follow up).
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	Unclear risk	There was no baseline imbalance. There was more non-compliance in the placebo group.
Randomised?	Low risk	Quote: "Patients were randomised blockwise."
Were both inclusion and exclusion criteria specified?	Low risk	Quote: "General practitioners (GP's) in the Greater Rotterdam were asked to report patients aged 0-12 years with nonbullous impetigo presenting at their surgery." Quote: "Exclusion criteria were..."

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Methods	April to December 2005; India, Mexico, Netherlands, Peru; hospital outpatients and general practice patients; only impetigo
Participants	0 to 73 years of age, mean age around 11 years M/F 107/103 S. aureus 146/210, S. pyogenes 42/210
Interventions	A: topical retapamulin 1% 2 td for 5 days B: topical placebo 2 td for 5 days
Outcomes	Outcomes of the trial 1) Cured or improved after 7 days
Notes	-
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Insufficient information was available.
Allocation concealment (selection bias)	Low risk	Quote: "Randomization was centre based and performed using an automated telephone system."
Blinding (performance bias and detection bias) patient	Low risk	Quote: "The packaging and labelling of study medication was identical for the active medication and its placebo counterpart. All efforts were made to make the study medication and placebo identical with respect to appearance and smell." The outcome assessor, caregiver, and participant were all blinded.
Incomplete outcome data (attrition bias) All outcomes	High risk	50/213 participants missing in total: 18/140 in the retapamulin group (1 did not receive intervention, 17 withdrawals (5 lack of efficacy, 3 disease progression, 2 decided to withdraw, 1 adverse event, 5 lost to follow up)), 33/73 in the placebo group (2 did not receive intervention, 31 withdrawals (18 lack of efficacy, 9 disease progression, 1 adverse event, 3 lost to follow up)). > 20% missing data.
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	Unclear risk	Quote: "The mean total lesion area at baseline was larger in the retapamulin group compared with the placebo group." There was an imbalance for age. There were no compliance data.
Randomised?	Low risk	Quote: "We carried out a randomized..."
Were both inclusion and exclusion criteria specified?	Low risk	Quote: "Inclusion criteria were..." Quote: "...were excluded."

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Methods	1974; Columbus, Ohio, USA; outpatients; only impetigo
Participants	2 months to 15 years M/F 14/16 S. aureus 22/30, S. pyogenes 10/30 PNE
Interventions	A: bacitracin ointment 500 units/g, 4 td + oral placebo 6 days B: erythromycin 250 mg 4 td + placebo cream, 6 days
Outcomes	Outcomes of the trial 1) 6 days, cured/improved
Notes	-
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote: "Drug assignment was based on a random distribution table, without the knowledge of the authors."
Allocation concealment (selection bias)	Low risk	See above.
Blinding (performance bias and detection bias) patient	Low risk	See above. Also double dummy design. The outcome assessor, caregiver, and participant were all blinded.
Incomplete outcome data (attrition bias) All outcomes	Low risk	0/30 participants were omitted in the analysis: 0/15 in the bacitracin group, 0/15 in the erythromycin group.
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	Unclear risk	There was no baseline comparison for the most important prognostic factors. There were no compliance data.
Randomised?	Low risk	Quote: "Drug assignment was based on a random distribution table, without the knowledge of the authors."
Were both inclusion and exclusion criteria specified?	Low risk	Quote: "...were enrolled in the study." Quote: "...were excluded."

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Methods	2002 to 2003; Japan; hospital outpatients; only impetigo
Participants	2 months to 13 years M/F 27/22 S. aureus 49/49 (inclusion criterion)
Interventions	A: topical tetracycline 3% 3 td + oral cefdinir 9 mg/kg/day for 7 days B: topical tetracycline 3% 3 td + oral minomycin 4 mg/kg/day for 7 days C: topical tetracycline 3% 3 td + oral fosfomycin 40 mg/kg/day for 7 days D: topical tetracycline 3% 3 td for 7 days
Outcomes	Outcomes of the trial 1) Cured, improved after 7 days
Notes	-
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	This was not reported.
Allocation concealment (selection bias)	Unclear risk	This was not reported.
Blinding (performance bias and detection bias) patient	High risk	Quote: "...open-label." The outcome assessor, caregiver, and participant were not blinded.
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	Only participants who were culture positive were analysed. The number of dropouts and withdrawals was not mentioned.
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	Unclear risk	There were no compliance data. There was a baseline comparison for age and sex - no imbalance.
Randomised?	Low risk	Quote: "...randomized".
Were both inclusion and exclusion criteria specified?	Low risk	Quote: "...were admitted to the study." Quote: "We excluded patients..."

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Methods	February to May 1986 ; Scottsdale, Arizona, USA; outpatients; only impetigo
Participants	> 6 months, average 5.5 years S.aureus 43/60, S.pyogenes 17/60 PE
Interventions	A: mupirocin ointment 2%, 3 td, 7 to 9 days B: erythromycin 30 to 40/mg/kg/day in 3 to 4 doses, 7 to 9 days
Outcomes	Outcomes of the trial 1) 8 to 12 days, very much improved/ improved/no change
Notes	-
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote: "Patients were randomized between the two treatment groups by a computer-generated set of random numbers in blocks of four."
Allocation concealment (selection bias)	Low risk	Quote: "...investigator was blinded to the treatment the patient was to receive at the time of patient entry."
Blinding (performance bias and detection bias) patient	High risk	Quote: "The investigator was blinded to the treatment the patient was to receive at the time of patient entry and was unblinded only in those cases where lesions persisted requiring additional culturing." Quote: "...open-label". This was not blinded for all participants. Also topical versus oral treatment. The outcome assessor and caregiver were not blinded.
Incomplete outcome data (attrition bias) All outcomes	Low risk	0/60 participants were omitted in the analysis for clinical efficacy: 0/30 in the mupirocin group, 0/30 in the erythromycin group (2 participants in the erythromycin group discontinued therapy because of severe adverse experiences).
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	Unclear risk	There was a severe baseline imbalance, more fever in erythromycin group (12 versus 3), but they seem to have adjusted for this in the analysis. There were no compliance data.
Randomised?	Low risk	Quote: "Patients were randomized between the two treatment groups by a computer-generated set of random numbers in blocks of four."
Were both inclusion and exclusion criteria specified?	Low risk	Quote: "...were enrolled in the study." Quote: "Patients with...were excluded."

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Methods	Time NR; San Juan, Puerto Rico; outpatients; only impetigo
Participants	6 months to 32 years, average 5.4 years M/F 27/26; S.aureus 44/53, GABHS 37/53 PE
Interventions	A: mupirocin ointment 2%, 3 td, 7 to 9 days C: erythromycin 30 to 50 mg/kg/day in 2 doses, 7 to 9 days
Outcomes	Outcomes of the trial 1) 7 to 9 days, cured/improved
Notes	-
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote: "Patients were randomized between the two treatment groups according to a computer-generated schedule having a block size of four."
Allocation concealment (selection bias)	Low risk	See above, and Quote: "The randomization was predetermined by the sponsor and the schedule for distribution of medications was entrusted to a team member whose assignment was to dispense medication."
Blinding (performance bias and detection bias) patient	Unclear risk	Quote: "...were examined in a investigator-blinded study." Quote: "The randomization was predetermined by the sponsor and the schedule for distribution of medications was entrusted to a team member whose assignment was to dispense medication." Also, there was treatment with ointment versus capsules. The outcome assessor was blinded. The caregiver and the participant were not blinded.
Incomplete outcome data (attrition bias) All outcomes	High risk	22/75 participants were omitted in the analysis: 9 were missing in the mupirocin group (unclear why), 13 were missing in the in the erythromycin group (unclear why).
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	Unclear risk	There was an imbalance for sex: 17/28 versus 10/25 boys (assessable participants) = 61% vs 40%. There was no compliance data.
Randomised?	Low risk	Quote: "Patients were randomized between the two treatment groups according to a computer-generated schedule having a block size of four."
Were both inclusion and exclusion criteria specified?	Low risk	Quote: "Patients 3 months of age and older of either sex who had no more than seven lesions of impetigo, cellulitis, abscesses, or furunculosis were admitted to the study."

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Methods	Time NR; multicentre; Columbia Guatemala, Panama, South Africa; outpatients; range of skin infections (including impetigo 95/200)
Participants	6 months to 12 years M/F 101/94 (all participants) S.aureus 109/200, S.pyogenes 39/200 PNE
Interventions	A: azithromycin susp 10 mg/kg/day once daily, 3 days B: cefaclor susp 20 mg/kg/day in 3 doses, 10 days
Outcomes	Outcomes of the trial 1) 10 to 14 days, cured + improved
Notes	-
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Insufficient information was available.
Allocation concealment (selection bias)	Unclear risk	Quote: "Patients were randomly assigned in a 1:1 ratio to receive either..." It is unclear whether participants and investigators enrolling participants could foresee assignment.
Blinding (performance bias and detection bias) patient	High risk	Quote: "This open, comparative study..." Participants in both groups did not receive the same administrations of study drugs daily. Comment: The outcome assessor, caregiver, and participant were probably not blinded.
Incomplete outcome data (attrition bias) All outcomes	Low risk	4/100 participants were omitted in the analysis (all attritions): 2/100 in the azithromycin group (due to loss of follow up), 2/100 in the cefaclor group (due to loss of follow up).
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	Unclear risk	There was no baseline imbalance for gender, age, weight, height, and ethnic origin. There were no compliance data.
Randomised?	Low risk	Quote: "Patients were randomly assigned in a 1:1 ratio to receive either..."
Were both inclusion and exclusion criteria specified?	Low risk	Quote: "Two hundred children...entered this multicentre..." Quote: "Patients were excluded from the study if...shown in Table I."

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Methods	Time NR; Rio de Janeiro, Brasil; hospital outpatients; only impetigo
Participants	Newborns, age 3 to 14 days, average 11 days M/F 25/23 S.aureus 100% (required for inclusion)
Interventions	4 arms: A: sodium fusidate ointment 2%, 3 td, 10 days B: chloramphenicol ointment, 3 td, 10 days C: neomycin/bacitracin ointment, 3 td, 10 days D: erythromycin oral 50 mg/kg/day, in 4 dd, 10 days
Outcomes	Outcomes of the trial 1) 7 days, cure
Notes	-
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Insufficient information was available.
Allocation concealment (selection bias)	Unclear risk	Insufficient information was available.
Blinding (performance bias and detection bias) patient	High risk	Oral versus topical treatment. The outcome assessor, caregiver, and participant were probably not blinded.
Incomplete outcome data (attrition bias) All outcomes	Low risk	All 48 participants were analysed (see table 2).
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	Unclear risk	There were no differences for sex. No other characteristics were reported. There were no compliance data.
Randomised?	Low risk	Quote: "Estes foram divididos aleatoriamente em quatro grupos de 12." [They were randomly divided in 4 groups of 12.]
Were both inclusion and exclusion criteria specified?	High risk	Quote: "Quarenta e oito recem-nascidos entre tres e 14 dias de idade, portadores de impetigo estafilococico sem tratamento topica ou oral anterior, foram incluidos neste estudo." [40 and 8 neonates between 3 and 14 days old, who were carriers of impetigo stafylococcus without previous topical or oral treatment, had been enclosed in this study.] No exclusion criteria was specified.

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Methods	Time NR; Plymouth/Bristol, UK; general practice; range of skin infections (including impetigo 89/354)
Participants	1 to 92 years, average 33 years (all participants) M/F 162/192 (all participants) S.aureus 119/344, S.pyogenes 15/344, both 25/344 (all participants) PNE
Interventions	A: fusidic acid ointment 2%, 3 td, up to 7 days B: mupirocin ointment 2%, 3 td, up to 7 days
Outcomes	Outcomes of the trial 1) 6 to 8 days, excellent/good
Notes	-
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Insufficient information was available.
Allocation concealment (selection bias)	Low risk	Quote: "On entry, patients were allocated at random to receive one or other treatment, tubes of the ointment being provided in plain sealed numbered containers so that the investigator was unaware of the treatment given." Comment: This was probably done.
Blinding (performance bias and detection bias) patient	Unclear risk	Quote: "On entry, patients were allocated at random to receive one or the other treatment, tubes of the ointment being provided in plain sealed numbered containers so that the investigator was unaware of the treatment given." Comment: The participants were probably blinded because the tubes were plain sealed. The outcome assessor was blinded. It is unclear whether the caregiver was blinded (it is unclear if the outcome assessor was also the caregiver).
Incomplete outcome data (attrition bias) All outcomes	Low risk	0/354 participants were omitted in the analysis: 0/191 in the sodium fusidate group, 0/163 in the mupirocin group. Therapy was withdrawn in only 2 cases - 1 in each treatment group.
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	Unclear risk	There was baseline comparison for sex, age, and severity. There were no compliance data.
Randomised?	Low risk	Quote: "On entry, patients were allocated at random to receive one or other treatment."
Were both inclusion and exclusion criteria specified?	Low risk	Quote: "The study involved 354 patients with acute superficial skin sepsis amenable to therapy with a topical antibiotic." Quote: "Patients who...were excluded."   Quote: "...were also exclusion factors."

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Methods	Time NR; Münster, Germany; outpatients; range of skin infections (including impetigo 66/80)
Participants	1 to 65 years, average 24 years M/F 35/31 S.aureus 41/66, GABHS 8/66, both 17/66 PE
Interventions	A: sulconazole nitrate cream 1%, 2 td, 14 days B: miconazole nitrate cream 2%, 2 td, 14 days
Outcomes	Outcomes of the trial 1) 7 days/14 days, cure
Notes	-
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote: "When patients enrolled in the trial, they were allocated, according to a computer-generated randomization code, to receive either..."
Allocation concealment (selection bias)	Unclear risk	Insufficient information was available.
Blinding (performance bias and detection bias) patient	Unclear risk	Quote: "...double-blind, parallel comparative study". It is unclear if, and how, the outcome assessor, caregiver, and participant were blinded.
Incomplete outcome data (attrition bias) All outcomes	Low risk	0/80 participants were omitted in the analysis: 0/40 in the sulconazole group, 0/40 in the miconazole group.
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	Unclear risk	The proportion of micro-organisms isolated at admission differs between groups (19 vs 6 for streptococcus, 53 vs 71 for S. aureus). There were no compliance data.
Randomised?	Low risk	Quote: "...according to a computer-generated randomization code..."
Were both inclusion and exclusion criteria specified?	Low risk	Quote: "Patients...were admitted to the trial." Quote: "...were excluded from the trial."

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Methods	2005; Canada, Costa Rica, France, Germany, India, The Netherlands, Peru, Poland, South Africa; outpatients; only impetigo
Participants	9 months to 84 years M/F 278/239 S. aureus 341/517, S. pyogenes 137/517
Interventions	A: topical retapamulin 1% 2 td for 5 days B: topical sodium fusidate 2% 3 td for 7 days
Outcomes	Outcomes of the trial 1) Cure or improvement after 7 (retapamulin) or 9 days (sodium fusidate)
Notes	Randomisation was 2:1.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	This was not reported.
Allocation concealment (selection bias)	Low risk	Quote: "...predetermined, center-based 2:1 schedule using the telephone-based interactive, central Registration and Medication Ordering System."
Blinding (performance bias and detection bias) patient	Unclear risk	Quote: "...observer-blinded..." Quote: "...helped protect investigator blinding." Quote: "To maintain observer blinding..." Participants in both groups did not receive the same administrations of study drugs daily. Participants were not blinded, the outcome assessor was blinded, and the blinding of the caregiver is unclear
Incomplete outcome data (attrition bias) All outcomes	Low risk	41/519 participants were missing data in both groups: 26/346 in the retapamulin group (26 prematurely discontinued, of which 8 had disease progression, 8 were lost to follow up, 1 had adverse events, 1 through lack of efficacy, 1 through protocol violation, 1 through potential conflicts of interest, 3 through 'other'), 15/172 in the sodium fusidate group (15 prematurely discontinued, of which 6 had disease progression, 1 was lost to follow up, 1 through subject decision [participant decision?], 3 had adverse events, 1 through lack of efficacy, 3 through 'other'), 1/519 were not included in the analysis.
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	Unclear risk	There was no baseline imbalance. Compliance was comparable.
Randomised?	Low risk	Quote: "This was a randomised..."
Were both inclusion and exclusion criteria specified?	Low risk	Quote: "Subjects were included if..." Quote: "Subjects were excluded if..."

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Methods	December 1988 to November 1990; Chiang Mai, Thailand; outpatients; only impetigo
Participants	1 months to 8 years, median 3.5 years M/F 64/46 (all participants) S. aureus 77/110 PE
Interventions	A: penicillin V potassium 50 mg/kg/day in 4 doses, 7 days B: cloxacillin sodium 50 mg/kg/day in 4 doses, 7 days
Outcomes	Outcomes of the trial 1) 7 days, cure
Notes	Bullous and non-bullous impetigo.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Insufficient information was available.
Allocation concealment (selection bias)	Unclear risk	It is unclear whether participants and investigators enrolling participants could foresee assignment.
Blinding (performance bias and detection bias) patient	High risk	This was not mentioned in the article: If the outcome assessor, caregiver, or participant was not blinded, he or she is likely to cause bias. All 3 were probably not blinded.
Incomplete outcome data (attrition bias) All outcomes	High risk	20/110 participants were omitted in the analysis: 45 were treated in the penicillin group and 45 were in the cloxacillin group (9 were unavailable for follow-up and 11 were negative to culture - not specified per group).
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	Unclear risk	There were no baseline characteristics per group. There were no compliance data.
Randomised?	Low risk	Quote: "Participants were randomly assigned to receive either..."
Were both inclusion and exclusion criteria specified?	Low risk	Quote: "Children... were invited to participate in the study." Quote: "Inclusion criteria included..."

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Methods	April to November 1989; Baltimore, USA; outpatients and general practice; only impetigo
Participants	3 months to 16 years MF 53/30 Culture only in case of therapy failure PNE
Interventions	A: erythromycin ethynyl succinate 40 mg/kg/day in 4 doses, 10 days B: mupirocin ointment 2%, 3 td, 10 days
Outcomes	Outcomes of the trial 1) 9 to 11 days, cure/improved/failure
Notes	-
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Insufficient information was available.
Allocation concealment (selection bias)	Unclear risk	It is unclear whether participants and investigators enrolling participants could foresee assignment.
Blinding (performance bias and detection bias) patient	High risk	Quote: "In any clinical trial that is not blinded..." Also, oral versus topical treatment. The outcome assessor, caregiver, and participant were not blinded.
Incomplete outcome data (attrition bias) All outcomes	Low risk	10/93 participants were omitted in the analysis. The following were specified: 4/46 in the erythromycin group (4 did not return for follow-up), 6/47 in the mupirocin group (4 did not return for follow-up, 2 were excluded from completing the protocol, 1 had cellulites develop within a few hours after entry into the study, 1 whose primary provider added an oral antibiotic to the treatment regimen on day 3 of therapy even though the participant's condition was improving).
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	Low risk	The baseline characteristics were comparable. Compliance was good and comparable (table 6).
Randomised?	Low risk	Quote: "Children were randomly assigned to the two study groups."
Were both inclusion and exclusion criteria specified?	Low risk	Quote: "All children... were invited to participate." Quote: "Exclusion criteria included..."

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Methods	Time NR; USA; outpatients; secondary impetigo (all eczema)
Participants	9 to 87 years M/F 87/72 S. aureus 74/159, S. pyogenes 0/159
Interventions	A: topical mupirocin 2% 3 td + oral placebo for 10 days B: oral cephalexin 250 mg 4 td + topical placebo for 10 days
Outcomes	Outcomes of the trial 1) Cured or improved after 12 to 13 days
Notes	-
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Insufficient information was available.
Allocation concealment (selection bias)	Unclear risk	Insufficient information was available.
Blinding (performance bias and detection bias) patient	Low risk	Quote: "...double-blind, double-dummy, parallel-group trial..." The outcome assessor, caregiver, and participant were all blinded.
Incomplete outcome data (attrition bias) All outcomes	High risk	33/159 (> 20%) participants did not complete the study (not specified per group). All 159 were in the ITT analysis. Participants whose outcome was indeterminable were considered failures. This may have introduced bias.
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	Unclear risk	Quote: "Compliance was similar for both groups." Quote: "The mean SIRS scores were 20.5 for the mupirocin group and 19,1 for the cephalexin group (P = 0.09)." There was an imbalance for sex.
Randomised?	Low risk	Quote: "In this randomized..."
Were both inclusion and exclusion criteria specified?	Low risk	Quote: "Patients were eligible for entry into the trial if..." Quote: "Patients were excluded from the study if..."

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Methods	Time NR; multicentre; Costa Rica, Guatemala, Panama, Venezuela; outpatients; range of skin infections (including impetigo 39/118)
Participants	2 to 12 years, mean 5 years M/F NR S. aureus 69/118, S. pyogenes 9/118 (all participants) PNE
Interventions	3 arms: A: azithromycin 10 mg/kg/day (max. 500), once daily, 3 days B: dicloxacillin12.5 to 25 mg/kg/day in 4 doses, 7 days (see notes) C: flucloxacillin 500 to 2000 mg/day in 4 doses (see notes)
Outcomes	Outcomes of the trial 1) 7 to 10 days, cure/improved/failure
Notes	Randomisation was between azithromycin and, either, dicloxacillin or flucloxacillin; the treatment groups dicloxacillin and flucloxacillin are combined in the results
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Insufficient information was provided.
Allocation concealment (selection bias)	Unclear risk	Insufficient information was provided.
Blinding (performance bias and detection bias) patient	High risk	Quote: "An open, randomized..." The outcome assessor, caregiver, and participant were not blinded.
Incomplete outcome data (attrition bias) All outcomes	Low risk	Only 1 participant was missing (in which group was not specified).
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	Unclear risk	There was no baseline comparison (or compliance data) for the subgroup of impetigo participants.
Randomised?	Low risk	Quote: "An open, randomized..." Quote: "60 were randomized to receive..."
Were both inclusion and exclusion criteria specified?	Low risk	Quote: "Children...were eligible to enter this study." Quote: "Concurrent treatment with...was not permitted." Quote: "The principal exclusion criteria were..." Quote: "Persons were also excluded if..."

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Methods	Time NR; Dominican Republic; hospital outpatients; only impetigo
Participants	Age and M/F ratio NR Bacterial results NR PE
Interventions	A: mupirocin ointment 2%, 3 td, 10 to 12 days B: placebo/vehicle, 3 td, 10 to 12 days
Outcomes	Outcomes of the trial 1) 7 to 12 days, cure/improved
Notes	-
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Insufficient information was available.
Allocation concealment (selection bias)	Unclear risk	Insufficient information was available.
Blinding (performance bias and detection bias) patient	Unclear risk	Quote: "The medication was numerically labelled; the protocol ensured double-blind comparisons." Bactroban ointment versus vehicle ointment. It is not clear whether the caregiver and outcome assessor are the same person. There was unclear blinding of the outcome assessor. The participant and the caregiver were probably blinded.
Incomplete outcome data (attrition bias) All outcomes	High risk	Quote: "Fifty patients completed the study." The number of participants that entered into the study was not specified.
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	Unclear risk	There was no baseline data. There were no compliance data.
Randomised?	Low risk	Bactroban ointment versus vehicle ointment - so, probably randomised but not clearly described.
Were both inclusion and exclusion criteria specified?	High risk	Quote: "Patients with...entered in the study sequentially." No exclusion criteria was specified.

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Methods	Summer 1972; Dallas, USA; outpatients; only impetigo
Participants	Children, age NR M/F 43/59 Only GABHS 33/102, both S. aureus and GABHS 57/102 PNE
Interventions	5 arms: A: phenoxymethyl penicillin 40 to 60,000 units/kg/day in 3 doses + HS B: phenoxymethyl penicillin 40 to 60,000 units/kg/day in 3 doses C: HS + placebo D: placebo, 3 td E: bacitracin ointment, 2 td
Outcomes	Outcomes of the trial 1) 5 days, cure
Notes	-
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote: "Patients were assigned to one of five treatment groups by a random numbers list." Quote: "When more than one child from an household was entered in the study, all those children received the same treatment." Comment: This was probably done.
Allocation concealment (selection bias)	High risk	Quote: "Patients were assigned to one of five treatment groups by a random numbers list." Quote: "When more than one child from an household was entered in the study, all those children received the same treatment." Investigators knew that children in the same household got the same treatment.
Blinding (performance bias and detection bias) patient	High risk	Quote: "Phenoxymethyl penicillin suspension and placebo were coded as 'impecillin' and 'tigocillin'". Also, ointment versus suspension. The bacitracin was not placebo-controlled. Comment: The outcome assessor, caregiver, and participant were probably not blinded.
Incomplete outcome data (attrition bias) All outcomes	High risk	24/102 participants were omitted in the analysis: 0/20 in group A (penicillin + hexachlorophene), 2/20 in group B (penicillin) (2 not streptococcal positive), 12/23 in group C (placebo) (6 not streptococcal positive, 6 failed to return for first follow-up), 4/17 in group D (placebo+hexachlorophene) (2 not streptococcal positive, 2 failed to return for first follow-up;), 6/22 in group E (bacitracin) (2 not streptococcal positive, 4 failed to return for first follow-up).
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	Unclear risk	There was no baseline imbalance. Compliance was good for penicillin (based on urine test) but not reported for other therapy.
Randomised?	Low risk	Quote: "Patients were assigned to one of five treatment groups by a random numbers list."
Were both inclusion and exclusion criteria specified?	High risk	Quote: "Children with... were excluded." Quote: "All patients were seen".

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Methods	Time NR; UK; general practice (n = 20); only impetigo (only facial)
Participants	1 months to 77 years, average 22 years M/F 84/93 S. aureus 68/177 PNE
Interventions	A: fusidic acid cream 3 td, 6 to 8 days B: mupirocin ointment 3 td, 6 to 8 days
Outcomes	Outcomes of the trial 1) 8 days, cure + improved
Notes	-
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Insufficient information was provided.
Allocation concealment (selection bias)	Unclear risk	Insufficient information was provided.
Blinding (performance bias and detection bias) patient	Unclear risk	Quote: "Investigators were not aware of the treatment given until the study was completed." Quote: "Treatment was allocated randomly in a double-blind manner, medication [was] dispensed in numbered, sealed containers." There was unclear blinding of the caregivers because it is unclear whether this is the same person as the outcome assessor. The participants were blinded.
Incomplete outcome data (attrition bias) All outcomes	High risk	24/201 were omitted in the analysis: 93 were left in the fusidic acid group, 84 were left in the mupirocin group (not further specified). 177/201 were in the analysis. Of the 24 participants who were not analysed for efficacy, 20 returned for follow-up after more than 8 days, 2 defaulted, and 2 violated the study protocol.
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	Unclear risk	There was no baseline imbalance. There were no compliance data.
Randomised?	Low risk	Quote: "Treatment was allocated randomly in a double-blind manner."
Were both inclusion and exclusion criteria specified?	Low risk	Quote: "A total of 201 patients requiring topical antibiotic treatment for facial impetigo were enrolled". Quote: "Exclusion criteria were..."

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Methods	1992 July to 1993 August; multicentre; US; outpatients; range of skin infections (including impetigo 225/394)
Participants	0 to 13 years (median 5.4) M/F 217/197 S. aureus 284/394 (all participants) PE
Interventions	A: cefdinir 7 mg/kg/day , 2 td, 10 days B: cephalexin 10 mg/kg/day, 4 td, 10 days
Outcomes	Outcomes of the trial 1) 7 to 14 day, cure
Notes	-
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Insufficient information was provided.
Allocation concealment (selection bias)	Unclear risk	It is unclear whether participants and investigators enrolling participants could foresee assignment.
Blinding (performance bias and detection bias) patient	Unclear risk	Quote: "...a multicenter, randomized, controlled, investigator-blind..." Also, participants in both groups did not receive the same administrations of study drugs daily. The outcome assessor was blinded. The caregiver and participant were not blinded.
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	Quote: "...number of patients excluded for each reason comparable among groups." The proportion of participants not evaluable for reasons of non-compliance was unclear. Quote: "An intention-to-treat analysis was also performed. This analysis counted as failures all patients who had negative admission cultures or for whom follow-up information was not available."
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	Unclear risk	There was no baseline imbalance (sex, age, race, infection type). There were no compliance data.
Randomised?	Low risk	Quote: "...a multicenter, randomized, controlled, investigator-blind..."
Were both inclusion and exclusion criteria specified?	Low risk	Quote: "Pediatric patients...were eligible for study entry." Quote: "Patients were prohibited from entering the study if..."

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Methods	January to December 1992; multicentre; USA; outpatients, range of skin infections (including impetigo 62/952)
Participants	13 to 88 years M/F 564/388 (all participants) S. aureus 308/382 (all participants) PE
Interventions	A: cefdinir caps 300 mg, 2 td, 10 days B: cephalexin caps 500 mg, 4 td, 10 days
Outcomes	Outcomes of the trial 1) 7 to 16 days, cure/improved
Notes	-
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Insufficient information was provided.
Allocation concealment (selection bias)	Unclear risk	Insufficient information was provided.
Blinding (performance bias and detection bias) patient	Unclear risk	Quote: "This was a double-mask, comparative, multicenter study." Quote: "Matched placebo capsules were dispensed appropriately to maintain study masking." It is not clear who was blinded (and how). It is unclear whether the outcome assessor and caregiver were blinded. The participants were blinded.
Incomplete outcome data (attrition bias) All outcomes	High risk	952 randomised participants. Quote: "Of these, 178 cefdinir patients and 204 cephalexin patients were considered microbiologically assessable and were included in the efficacy analyses." > 20% not included in efficacy analysis because they were not assessed or the study drug was not taken as prescribed (table III). There was no intention-to-treat analysis.
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	Unclear risk	Groups were similar at baseline (table II), though not specified for impetigo participants. There were no compliance data.
Randomised?	Low risk	Quote: "Patients were randomized 1:1 to receive..."
Were both inclusion and exclusion criteria specified?	Low risk	Quote: "Eligible patients were..." Quote: "Exclusion criteria included..."

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Methods	Time NR; Mexico; outpatients; only impetigo
Participants	6 months to 12 years, average 4 years 8 months M/F 14/16 S. aureus 18/30, S. pyogenes 4/30, both 1/30 PE: not clear
Interventions	A: rifamycin spray, 2 td, 7 days B: mupirocin ointment 2%, 2 td, 7 days
Outcomes	Outcomes of the trial 1) 1 week, cure/improved
Notes	Both primary (n = 17) and secondary (n = 13) impetigo participants were studied.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Insufficient information was available.
Allocation concealment (selection bias)	Unclear risk	Insufficient information was available.
Blinding (performance bias and detection bias) patient	High risk	Quote: "...open trial". Also, spray versus ointment. The caregiver, outcome assessor, and participant were not blinded.
Incomplete outcome data (attrition bias) All outcomes	Low risk	0/30 participants were omitted in the analysis: 0/15 in the rifamycin group, 0/15 in the mupirocin group.
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	Unclear risk	There was no baseline imbalance. There were no compliance data.
Randomised?	Low risk	Quote: "...fueron asignados al azar." [...were assigned at random.]
Were both inclusion and exclusion criteria specified?	Low risk	Quote: "En este estudio únicamente se incluyeron pacientes con lesiones localizades, con área no mayor de 10 cm² Los criterios de exclusión fueron niños con lesiones con un tiempo de evolución mayor de un mes." [In this study, patients were only included if the lesions were smaller than 10 cm². Exclusion criteria were children with lesions present longer than 1 month].

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Methods	Time NR; multicentre; Europe and South America; hospital-admitted and outpatients; range of skin infections (including impetigo 42/172)
Participants	Age 18 to 99 years M/F 159/125 (all part) S. aureus 58% (all participants) PE
Interventions	A: fleroxacin 400 mg, 1 td, 7 to 21 days B: amoxicillin/clavulanic acid tablets 500/125 mg, 3 td, 7 to 21 days
Outcomes	Outcomes of the trial 1) 7 days, cure
Notes	-
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Insufficient information was available.
Allocation concealment (selection bias)	Unclear risk	Insufficient information was available
Blinding (performance bias and detection bias) patient	High risk	Quote: "...open-label". Participants in both groups did not receive the same administrations of study drugs daily. Also, investigators enrolling participants could possibly foresee assignment. The outcome assessor, caregiver, and participant were not blinded.
Incomplete outcome data (attrition bias) All outcomes	High risk	Not only impetigo - it was not specified how many impetigo participants were randomised and included. 27 were analysed in the fleroxacin group, 15 were analysed in the amoxicillin/clavulanic group. Further data was not specified for impetigo participants. Not all participants were assessable for the efficacy analysis, but it was not stated how many.
Selective reporting (reporting bias)	Unclear risk	This was not unclear.
Other bias	Unclear risk	There was no baseline imbalance. There were no compliance data.
Randomised?	Low risk	Quote: "This study was designed as a prospective, randomized, open label..."
Were both inclusion and exclusion criteria specified?	Low risk	Quote: "Inpatients or outpatients of either sex were eligible for inclusion in the study if..." Quote: "Exclusion criteria were..."

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Methods	March 1982 to January 1984; Denmark; general practice; only impetigo
Participants	Age 1 to 77, average 11 years M/F 71/57 No bacterial culture done PNE
Interventions	3 arms: A: fusidic acid cream 2% B: tetracycline/polymyxin B ointment C: neomycin/bacitracin ointment
Outcomes	Outcomes of the trial 1) 1 week, cure/improved
Notes	-
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Insufficient information was available.
Allocation concealment (selection bias)	Unclear risk	Insufficient information was available.
Blinding (performance bias and detection bias) patient	Unclear risk	Quote: "Undersøgelsen var således blindet for lægen, men ikke for patienten." [The study was blinded for the doctor, but not for the patient.] The outcome assessor and caregiver were blinded. Participants were not blinded.
Incomplete outcome data (attrition bias) All outcomes	Low risk	6/134 participants were not included in the analysis: unknown group assignment, reasons were given.
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	Unclear risk	There was no baseline imbalance for severity. The used medication is in table 2. There were no compliance data.
Randomised?	Low risk	Quote: "...randomiseringsnummer." [...randomisation number.]
Were both inclusion and exclusion criteria specified?	Low risk	Quote: "For at indgå i study skulle patienterne have klinisk verificeret impetigo"; "Udelukket var patienter med impetigeniserede eksemer, patienter med..." [Patients were eligible if they had clinical verified impetigo; Excluded were patients with impetiginised eczema and patients with...]

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Methods	1974; multicentre; USA; outpatients; only impetigo (secondary)
Participants	Age/sex NR S. aureus 62/79 PNE
Interventions	3 arms: A: betamethasone valerate cream, 3 td B: gentamycin cream, 3 td C: betamethasone + gentamycin cream, 3 td
Outcomes	Outcomes of the trial 1) 3 weeks, excellent result
Notes	Secondary impetigo (impetiginised atopic dermatitis)
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Insufficient information was available.
Allocation concealment (selection bias)	Unclear risk	Insufficient information was available
Blinding (performance bias and detection bias) patient	Low risk	Quote: "...precautions being observed to preserve the blinding of both patients and therapists." Also, participants in both groups received the same administrations of study drugs daily. The outcome assessor, caregiver, and participant were blinded.
Incomplete outcome data (attrition bias) All outcomes	Low risk	4/83 participants were omitted in the analysis (not further specified).
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	Unclear risk	There was a baseline comparison for severity and no imbalance. There were no compliance data.
Randomised?	Low risk	Quote: "Patients under the care of an individual investigator were randomly assigned."
Were both inclusion and exclusion criteria specified?	Low risk	Quote: "All patients enrolled were clinically judged to have moderate to severe impetiginized..." Quote: "In order to be accepted for the study..." Quote: " ...were excluded."

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Methods	Time NR; London, UK; outpatients and general practice; range of skin infections (including impetigo 16/39)
Participants	Age NR M/F 25/14 (all participants) S. aureus 31/48 (all participants) PE: not clear
Interventions	A: mupirocin ointment 2%, 2 td, 7 to 14 days B: chlortetracycline cream 3%, 2 td, 7 to 14 days
Outcomes	Outcomes of the trial 1) 7 days, cure/improved
Notes	-
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Insufficient information was available.
Allocation concealment (selection bias)	Unclear risk	Insufficient information was available.
Blinding (performance bias and detection bias) patient	Unclear risk	Quote: "Thirty-nine patients were entered in a randomized, observer-blind trail." Quote: "...but the medications were packaged identically and not opened in the presence of the physician." The outcome assessor and caregiver were blinded. Participants were not blinded.
Incomplete outcome data (attrition bias) All outcomes	Low risk	3/39 participants were omitted in the analysis: 2/22 in the mupirocin group, 1/17 in the chlortetracycline group. These 3 were excluded from the analysis of results as they received systemic antibiotics for other infections while in the study.
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	Unclear risk	There was a baseline imbalance for age (all infants were in the Bactroban group). This was not specified for impetigo. There were no compliance data.
Randomised?	Low risk	Quote: "Thirty-nine patients were entered in a randomized, observer-blind trail."
Were both inclusion and exclusion criteria specified?	High risk	Quote: "Patients with lesions suitable for treatment with a topical antibiotic were entered in the study." No exclusion criteria was specified.

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Methods	Time NR; Monterrey, Mexico; outpatients; range of skin infections (including impetigo 15/60)
Participants	Age NR M/F 32/28 S. aureus 47/50 PNE
Interventions	A: mupirocin ointment 2%, 3 td, 5 to 10 days B: ampicillin 50 mg, 4 td, 5 to 10 days
Outcomes	Outcomes of the trial 1) 10 days, cure/improved
Notes	-
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Insufficient information was available.
Allocation concealment (selection bias)	Unclear risk	Insufficient information was available.
Blinding (performance bias and detection bias) patient	High risk	Quote: "...in an open trial." Thereby, the participants in both groups did not receive the same administrations of study drugs daily. The outcome assessor, caregiver, and participant were not blinded.
Incomplete outcome data (attrition bias) All outcomes	Low risk	10/60 participants were omitted in the analysis: 5/32 in the mupirocin group were lost to follow up, 5/28 in the ampicillin group were lost to follow up. These 10 participants were not analysed.
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	Unclear risk	Quote: "Patient characteristics were similar in both treatment group in terms of sex, age, and weight." Table I shows no baseline imbalance for severity. There were no compliance data.
Randomised?	Low risk	Quote: "A randomized clinical trial..."
Were both inclusion and exclusion criteria specified?	Low risk	Quote: "...outpatients with primary and secondary skin infections." Quote: "Patients were excluded from entry into the trial on the basis of..."

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Methods	1985 to 1987; UK; general practice; range of skin infections (including impetigo 155/390)
Participants	Age 11 months to 84 years M/F NR S. aureus 43% (all participants) PNE
Interventions	A: mupirocin ointment 2%, 2 td, 7 days B: fusidic acid ointment 2%, 3 td, 7 days
Outcomes	Outcomes of the trial 1) 7 days, cure/improved
Notes	-
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Insufficient information was available.
Allocation concealment (selection bias)	Low risk	Quote: "...and patients were randomised to receive treatment with either..." Quote: "For this purpose, a code was designed in blocks of six..." Quote: "The tubes were supplied in a sealed box labelled with the patient's number. Thereby the observer did not know which antibiotic a patient was receiving." Comment: This was probably done.
Blinding (performance bias and detection bias) patient	Unclear risk	Quote: "Four plain tubes containing the preparations were supplied for each patient. These were labelled with instructions for use but the name of the antibiotic was omitted. Mupirocin was to be applied twice daily and sodium fusidate thrice daily." Quote: "The tubes were supplied in a sealed box labelled with the patient's number. Thereby the observer did not know which antibiotic a patient was receiving." The outcome assessor was blinded. The caregiver and participant were probably not blinded because they did not receive the same administrations of study drugs daily.
Incomplete outcome data (attrition bias) All outcomes	High risk	23/413 participants were omitted in the analysis: 12/275 in the mupirocin group (8 failed to attend for assessment, 1 withdrew due to revised diagnosis, 3 were prescribed antibiotics for reasons other than lack of efficacy), 11/138 in the sodium fusidate group (3 failed to attend for assessment, 1 withdrew due to revised diagnosis, 2 were prescribed antibiotics for reasons other than lack of efficacy, 4 due to non-compliance, 1 due to inadequate data). < 20% dropouts, but reasons were not balanced between the groups.
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	Unclear risk	Quote: "There was a similar distribution of type and severity of infection between the two treatment groups". There were no compliance data.
Randomised?	Low risk	Quote: "...observer-blind randomised multi-centre clinical trial."
Were both inclusion and exclusion criteria specified?	Low risk	Quote: "Any patient with primary or secondary skin infection, other than...was eligible for entry." Quote: "Patients were excluded if..."

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Methods	Time NR; Quebec, Canada; outpatients; range of skin infections (including impetigo 10/50)
Participants	Age/sex NR S. aureus 18/50 (all participants) PE: not clear
Interventions	A: mupirocin 2%, 3 td, 7 days B: polymyxin B-neomycin (Neosporin), 3 td, 7 days
Outcomes	Outcomes of the trial 1) 7 days, cure/improved
Notes	-
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Insufficient information was available.
Allocation concealment (selection bias)	Unclear risk	Insufficient information was available.
Blinding (performance bias and detection bias) patient	Unclear risk	Quote: "...double-blind fashion." It was unclear how, and if, the outcome assessor, caregiver, and participant were blinded.
Incomplete outcome data (attrition bias) All outcomes	Low risk	There were 0/10 missing impetigo participants: 0/4 missing in the mupirocin group, 0/6 missing in the neosporin group.
Selective reporting (reporting bias)	Unclear risk	This was unclear.
Other bias	Unclear risk	There were no baseline characteristics. There were no compliance data.
Randomised?	Low risk	Quote: "...were randomly divided into..."
Were both inclusion and exclusion criteria specified?	Low risk	Quote: "Fifty patients who appeared at the dermatologic clinic with primary and secondary skin infections of...were randomly divided..." Quote: "...were excluded from the trial."

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Characteristics of excluded studies [ordered by study ID]

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Study	Reason for exclusion
Alavena 1987	Randomisation was inadequate.
Anonymous 1998	Results were not separately described for impetigo participants: no randomisation.
Arata 1983	Randomisation was inadequate (serial allocation).
Arata 1994	The results were not separately described for impetigo participants.
Arosemena 1977	The results were not separately described for impetigo participants: only 6/343 participants had impetigo.
Azimi 1999	The results were not separately described for impetigo participants.
Baldwin 1981	The same drug was compared.
Ballantyne 1982	The results were not separately described for impetigo participants: no randomisation.
Bastin 1982	The results were not separately described for impetigo participants.
Bernard 1997	The results were not separately described for impetigo participants (requested, but no reply).
Bin Jaafar 1987	No participants had impetigo ( "pyoderma").
Burnett 1963	There was no randomisation.
Cassels-Brown 1981	The design was unacceptable (no RCT).
Colin 1988	The results were not separately described for impetigo participants.
Cordero 1976	There was only 1 impetigo participant.
De Waard 1967	There was no randomisation: 2 arms with the same active drug (though different mode of administration).
Dillon 1970	There was no randomisation.
Dillon 1979a	The results were not separately described for impetigo participants.
Drehobl 1997	The results were not separately described for impetigo participants (requested, but no reply).
el Mofty 1990	The results were not separately described for impetigo participants.
Esterly 1970	There was no randomisation.
Faingezicht 1992	The results were not separately described for impetigo participants.
Fedorovskaia 1989	Randomisation was inadequate.
Fleisher 1983	The results were not separately described for impetigo participants.
Forbes 1952	The same drug was compared.
Free 2006	No participants had impetigo (communication: Nicole E. Scangarella).
Gentry 1985	The results were not separately described for impetigo participants.
Gibbs 1987	All impetigo participants received the same treatment.
Golcman 1997	The results were not separately described for impetigo participants (requested, but no reply).
Goldfarb 1987	The results were not separately described for impetigo participants.
Gooch 1991	The results were not separately described for impetigo participants.
Hanfling 1992	The results were not separately described for impetigo participants.
Harding 1970	There was 1 drug (flucloxacillin) in 2 doses: the results for impetigo participants were not separately described.
Heskel 1992	The results were not separately described for impetigo participants.
Jacobs 1992	The results were not separately described for impetigo participants.
Jennings 1999	There was only 1 impetigo participant.
Jennings 2003	The results were not separately described for impetigo participants (requested, but no reply).
Keeny 1979	The results were not separately described for impetigo participants.
Kotrajaras 1973	The results were not separately described for impetigo participants.
Kumakiri 1988	There was only 1 impetigo participant.
Kumar 1988	No participants had impetigo: 2 forms of the same drug.
Lassus 1990	The results were not separately described for impetigo participants.
Lentino 1984	There was only 1 impetigo participant.
Levenstein 1982	The results were not separately described for impetigo participants.
Lewis-Jones 1985	The results were not separately described for impetigo participants.
Linder 1978	The results were not separately described for impetigo participants.
Linder 1993	The results were not separately described for impetigo participants.
Lipets 1987	No comparison was made.
Liu 1986	No participants had impetigo (impetigo herpetiformis).
MacKenna 1945	Randomisation (serial allocation) was inadequate.
Macotela-Ruiz 1988	The results were not separately described for impetigo participants (requested, but no reply).
Mallory 1991	The results were not separately described for impetigo participants.
Manaktala 2009	The results were not separately described for impetigo participants.
McCarty 1992	The results were not separately described for impetigo participants.
McMillan 1969	The results were not separately described for impetigo participants.
Milidiú d Silva 1985	The results were not separately described for impetigo participants.
Nakayama 1983	The results were not separately described for impetigo participants, and it was not an RCT.
Neldner 1991	The results were not separately described for impetigo participants.
Nichols 1997	The results were not separately described for impetigo participants.
Nicolle 1990	The results were not separately described for impetigo participants.
Nolting 1992	No participants had impetigo (pyoderma).
Orecchio 1986	The results were not separately described for impetigo participants.
Pakrooh 1978	No participants had impetigo.
Palazzini 1993	The results were not separately described for impetigo participants.
Parish 1984	The results were not separately described for impetigo participants.
Parish 1991	The results were not separately described for impetigo participants.
Parish 1992	The results were not separately described for impetigo participants.
Parish 1997	The results were not separately described for impetigo participants.
Parish 2000	The results were not separately described for impetigo participants (requested, but no data available).
Parish 2006	No participants had impetigo (communication: Nicole E. Scangarella).
Park 1993	There was no randomisation (personal communication: Seungsoo Sheen).
Pien 1983	The results were not separately described for impetigo participants.
Powers 1991	There were no separate results for clinical cure.
Powers 1993	There were only 2 impetigo participants.
Pusponegoro 1990	There was only 1 impetigo participant,
Risser 1985	The results were not separately described for impetigo participants.
Saenz 1985	The results were not separately described for impetigo participants.
Salzberg 1972	There was only 1 impetigo participant.
Schupbach 1992	The results were not separately described for impetigo participants.
Schwartz 1996	There was only 1 impetigo participant.
Smith 1985	The results were not separately described for impetigo participants.
Smith 1993	There was only 1 impetigo participant.
Sobye 1966	The results were not separately described for impetigo participants.
Stevens 1993	There were 5 participants with "pyoderma".
Tack 1991	The results were not separately described for impetigo participants, and the same drug was compared.
Török 2004	The same drug was compared.
Urbach 1966	No randomisation was described.
Van der Auwera 1985	No participants had impetigo.
Villiger 1986	The results were not separately described for impetigo participants.
Wachs 1992	The results were not separately described for impetigo participants.
Wible 2003	The results were not separately described for impetigo participants (requested, but no reply).
Wolbling 1987	2 doses of 1 drug were compared.
Wong 1989	The results were not separately described for impetigo participants.
Yura 1988	The results were not separately described for impetigo participants.

---

 

Characteristics of studies awaiting assessment [ordered by study ID]

---

Methods	This is an RCT.
Participants	Age 6 months to 18 years with uncomplicated skin and soft tissue infections
Interventions	Intervention A: clindamycin Control intervention B: cephalexin
Outcomes	Primary outcomes of the trial 1) Improvement Secondary outcomes of the trial 1) Complete resolution
Notes	This is a result of the CSG searches that were run in August 2011. It is not known how many participants were impetigo patients.

---

---

Methods	This is an RCT.
Participants	Various skin infections (including impetigo)
Interventions	Intervention A: cloxacillin Control intervention B: pristinamycin
Outcomes	Outcomes of the trial 1) Cure
Notes	This will be included when data on impetigo participants is provided.

---

---

Methods	Please see the 'notes' cell below.
Participants	Please see the 'notes' cell below.
Interventions	Please see the 'notes' cell below.
Outcomes	Please see the 'notes' cell below.
Notes	This is a result of the CSG searches that were run in August 2011. We were unable to obtain a copy of this trial.

---

---

Methods	This is possibly an RCT.
Participants	70 participants of different ages suffering from pyoderma, including infective dermatitis of which 30 participants had impetigo
Interventions	Intervention A: neem, haldi, sajina, and garlic oil (Nutriderm oil) Control intervention B: gentian violet
Outcomes	Primary outcomes of the trial 1) Cure Secondary outcomes of the trial 1) Side-effects
Notes	-

---

---

Methods	Please see the 'notes' cell below.
Participants	Please see the 'notes' cell below.
Interventions	Please see the 'notes' cell below.
Outcomes	Please see the 'notes' cell below.
Notes	This paper was published in Spanish, and we were unable to obtain a copy.

---

---

Methods	This is possibly an RCT.
Participants	200 children suffering from various types of pyoderma, 94 of which had impetigo
Interventions	Intervention A: injection benzathine penicillin Control intervention B: oral sulphamoxole
Outcomes	Outcomes of the trial 1) Cure after 1 and 2 weeks
Notes	There did not appear to be separate results for impetigo.

---

---

Methods	This is possibly an RCT.
Participants	200 children aged 10 months to 12 years suffering from pyoderma
Interventions	Intervention A: 125 mg amoxicilin plus 30 mg clavulanate per 5 ml of suspension, equivalent to 20 mg amoxicillin/kg/day in 3 divided doses Control interventions B: amoxicillin 20 mg/kg/day in 3 divided doses C: erythromycin 30 mg/kg/day in 4 divided doses D: co-trimoxazole (8 mg trimethoprim + 40 mg sulfamethoxazole/kg/day) in 2 divided dosis
Outcomes	Primary outcomes of the trial 1) Presence of S. aureus Secondary outcomes of the trial 1) Cure 2) Adverse events
Notes	It was not clear if pyoderma equated to impetigo.

---

---

Methods	This is an RCT.
Participants	162 households in Pakistan
Interventions	Intervention A: 1.2% triclocarban-containing soap Control intervention B: an identically appearing placebo
Outcomes	Outcomes of the trial 1) Impetigo incidence
Notes	This is a result of the CSG searches that were run in August 2011.

---

---

Methods	This is possibly an RCT.
Participants	136 children (1 day to 14 years) with impetigo
Interventions	Intervention A: sunflower oil Control intervention B: mupirocin
Outcomes	Primary outcomes of the trial 1) Clinical cure after possibly 6 days
Notes	This paper was written in Spanish.

---

---

Methods	This is an RCT.
Participants	Please see the 'notes' cell below.
Interventions	Please see the 'notes' cell below.
Outcomes	Please see the 'notes' cell below.
Notes	This is a result of the CSG searches that were run in August 2011. We were unable to obtain a copy of this trial.

---

---

Methods	This is an RCT.
Participants	Please see the 'notes' cell below.
Interventions	Please see the 'notes' cell below.
Outcomes	Please see the 'notes' cell below.
Notes	This is a result of the CSG searches that were run in August 2011. We were unable to obtain a copy of this trial.

---

---

Methods	This is possibly an RCT.
Participants	104 participants with impetigo
Interventions	Intervention A: tea lotion B: tea ointment C: soframycin D: oral cephalexin
Outcomes	Primary outcomes of the trial 1) Cure after 7 to 10 days
Notes	-

---

---

Methods	This is an RCT.
Participants	Please see the 'notes' cell below.
Interventions	Please see the 'notes' cell below.
Outcomes	Please see the 'notes' cell below.
Notes	This is a result of the CSG searches that were run in August 2011. We were unable to obtain a copy of this trial.

---

---

Methods	This is a pilot study.
Participants	13 participants with skin sores
Interventions	Intervention A: oral cotrimoxazole B: intramuscular benzathine penicillin
Outcomes	Primary outcomes of the trial 1) Resolution of skin sores
Notes	Australian Trial Register: Is cotrimoxazole safe and efficacious for treatment of skin sores in Aboriginal children: a pilot study Published in the Journal of Pediatrics and Child Health 2010;46:131-133

---

---

Methods	This is possibly an RCT.
Participants	Please see the 'notes' cell below.
Interventions	Please see the 'notes' cell below.
Outcomes	Please see the 'notes' cell below.
Notes	We were unable to obtain a copy of this trial.

---

---

Methods	This is possibly an RCT.
Participants	Please see the 'notes' cell below.
Interventions	Please see the 'notes' cell below.
Outcomes	Please see the 'notes' cell below.
Notes	We were unable to obtain a copy of this trial.

---

 

Characteristics of ongoing studies [ordered by study ID]

---

Trial name or title	An open label randomised controlled trial to determine if 5 days of once-daily oral trimethoprim-sulfamethoxazole or three days of twice-daily oral trimethoprim-sulfamethoxazole will lead to non-inferior cure rates of impetigo compared to a single dose of intramuscular benzathine penicillin G (the current gold standard treatment) in children living in remote Aboriginal communities between the age of 12 weeks to less than 13 years
Methods	See title.
Participants	Inclusion criteria of the trial 1. Age 12 weeks to less than 13 years at the time written consent is obtained 2. Diagnosis of purulent or crusted impetigo by criteria outlined in the Booklet "Recognising and Treating Skin Conditions" (East Arnhem Healthy Skin Program (EAHSP), Menzies School of Health Research 2006) 3. A resident in 1 of the participating (Aboriginal) communities at the time of enrolment and intending to stay in that community for the duration of the study (7 days post-randomisation)
Interventions	Group 1: single dose intramuscular benzathine penicillin G - weight band-based dosing up to 900 mg (> 3 and < 6 kg = 225 mg; > 6 and < 10 kg = 337.5 mg; > 10 and < 15 kg = 450 mg; > 15 and < 20 kg = 675 mg; > 20 kg = 900 mg) Group 2: trimethoprim-sulfamethoxazole oral suspension 8 + 40 mg/kg (max 320 + 1600 mg) daily for 5 days Group 3: trimethoprim-sulfamethoxazole oral suspension 4 + 20 mg/kg (max 160 + 800 mg) twice daily for 3 days
Outcomes	Primary outcomes of the trial 1) The proportion of children successfully treated on day 7 after the commencement of treatment within each of the respective groups. Successfully treated is defined as a child with impetigo which has been clinically classified as sore either healed or improved by a person blinded to the allocated randomisation Secondary outcomes of the trial 1) The proportion of children within each of the respective groups who are defined as being successfully treated on day 2  2) Prevalence of Staphylococcus aureus (methicillin susceptible and methicillin resistant) and Group A Streptococci per child at day 0, day 2, and day 7 within each treatment group as determined from impetigo swabs collected at the respective time points  3) Effect of each treatment on the bacterial resolution of sores at days 2 and 7 as determined by impetigo swabs collected at the respective time points  4) Prevalence of nasal carriage of Staphylococcus aureus at baseline and day 7 (including a comparison of the prevalence of methicillin-resistant S. aureus at baseline and day 7) 5) Evidence of allergy or other reaction to the medication within 7 days of first administration as determined by clinical observation and questioning of caregivers
Starting date	1st December 2009
Contact information	Ross Andrews ([e-mail]) Menzies School of Health Research PO Box 41096 Casuarina, 0811, NT, Australia
Notes	Australian New Zealand Clinical Trial Registry: ACTRN12609000858291

---

---

Trial name or title	An Open Labelled, Double Arm, Randomized, Multicentric, Prospective And Comparative, Phase-III Trial To Evaluate The Safety And Efficacy Of Fixed Dose Combination Of Ceftriaxone And Vancomycin Injection Vs. Vancomycin Injection In Subjects With Various Bacterial Infections
Methods	See above.
Participants	Inclusion criteria of the trial All subjects aged between 18 and 70 years Diagnosed subjects of infectious disease (on clinical evaluation). Subjects willing to give informed consent Subject suffering from any of the following infections - lower respiratory tract infections, skin and skin structure infections, endocarditic, bacterial meningitis and bone infection
Interventions	See above.
Outcomes	Primary outcomes of the trial 1) Compare the efficacy of a 3.0 g FDC of ceftriaxone and vancomycin injection vs 1.0 g vancomycin injection in subjects with mild to severe bacterial infections Secondary outcomes of the trial 1) Evaluate the safety of the test and comparative product
Starting date	8th April 2008
Contact information	[e-mail]
Notes	It is unclear whether impetigo participants will be included.

---

---

Trial name or title	Sisomicin Cream Vs Nadifloxacin Cream in Primary Pyodermas
Methods	This was to be a randomised, active-control trial. End point classification - safety/efficacy study Intervention model - parallel assignment Masking - open-label Primary purpose - treatment
Participants	Inclusion criteria of the trial Participants of either sex, suffering from primary pyodermas requiring topical antibiotic therapy without occlusive dressing, > = 6 years of age Written informed consent
Interventions	See title.
Outcomes	None were stated.
Starting date	May 2007
Contact information	Ragunandan Torsekar, MD, FCPS (Principal Investigator) Rajiv Gandhi Medical College
Notes	The current status of the trial is withdrawn (NCT00202891).

---

---

Trial name or title	Efficacy, Safety, and Tolerability of TD1414 2% Cream in Impetigo and Secondarily Infected Traumatic Lesions (SITL)
Methods	Quote: "This is an international, multicentre, prospective 3-arm parallel-group, phase II proof of concept study comparing the efficacy and safety of 2 dosage regimens (BID 7 days and TID 7 days) of TD1414 2% cream and 1 dosage regimen (BID 7 days) of Bactroban® (mupirocin) 2% cream in adults and children down to 2 years of age with impetigo or SITL. Furthermore, an evaluation of the pharmacokinetics of TD1414 2% cream TID for 7 days will be performed. A total of 664 patients will be enrolled in a stepwise manner according to age groups starting with the oldest age group."
Participants	See above.
Interventions	See above.
Outcomes	Primary outcomes of the trial 1) Clinical cure at end of treatment according to investigator's assessment Secondary outcomes of the trial 1) Clinical cure at follow-up according to investigator's assessment 2) Clinical cure at end of treatment and follow-up according to investigator's assessment 3) Bacteriological cure at end of treatment and follow-up
Starting date	February 2008
Contact information	Almena L Free, MD (Principal Investigator) Anniston Medical Clinic Anniston, Alabama, United States 36207
Notes	www.clinicaltrials.gov

---

---

Trial name or title	A Randomized, Double-Blind, Double Dummy, Comparative, Multicenter Study to Assess the Safety and Efficacy of Topical Retapamulin Ointment, 1%, Versus Oral Linezolid in the Treatment of Secondarily-Infected Traumatic Lesions and Impetigo Due to Methicillin-Resistant Staphylococcus Aureus
Methods	See above.
Participants	See above.
Interventions	See above.
Outcomes	Primary outcomes of the trial 1) Number of participants achieving clinical response at follow-up who had methicillin-resistant Staphylococcus aureus (MRSA) as a baseline pathogen Secondary outcomes of the trial 1) Number of participants achieving microbiological response at follow-up who had MRSA as a baseline pathogen 2) Number of participants with clinical response at follow-up 3) Number of participants who achieved microbiological response at follow-up who had a baseline pathogen 4) Number of participants with the indicated clinical outcome at the end of therapy who had MRSA as a baseline pathogen 5) Number of participants with the indicated microbiological outcome at the end of therapy who had MRSA as a baseline pathogen 6) Number of participants with the indicated clinical outcome at the end of therapy 7) Number of baseline pathogens with the indicated microbiological outcome at the end of therapy 8) Number of participants with therapeutic response at follow-up 9) Mean scores on the skin infection rating scale at visits 1, 2, 3, 4, and 5 10) Mean wound size at visits 1, 2, 3, 4, and 5
Starting date	April 2009
Contact information	Study Director GSK Clinical Trials GlaxoSmithKline
Notes	-

---

---

Trial name or title	A Phase IV Study Comparing Clinical and Bacteriological Efficacy of Fucidin® Cream With Fucidin® Cream Vehicle in the Treatment of Impetigo in Paediatric Patients
Methods	This is a randomised, placebo-controlled trial. End point classification - safety/efficacy Study Intervention model: parallel assignment Masking - double-blind (subject, investigator) Primary purpose - treatment
Participants	Inclusion criteria of the trial Participants with a clinical diagnosis of impetigo Participants aged 2 to 11 years Participants of either sex Participants whose parent(s) has/have provided written consent Participants with a severity score of 1 for at least 1 of the following signs: pustules/infected bullae, erythema, or infiltration/induration
Interventions	A: Fucidin^® cream versus Fucidin^® cream vehicle
Outcomes	Primary outcomes of the trial 1) The proportion of participants with clinical success (marked improvement or completely cleared) and bacteriological success (eradication) at end of treatment (EOT) Secondary outcomes of the trial 1) The proportion of participants with clinical and bacteriological success at visit 2 and 3, and at EOT 2) The actual change in Total Severity Score from baseline to end of treatment 3) The distribution of individual sign scores at end of treatment
Starting date	May 2004
Contact information	Inga Odenholt (Principal Investigator) Malmö University Hospital
Notes	Infomation was obtained from clinicaltrials.gov. Information was requested in August 2010.

---

---

Trial name or title	A Randomized, Parallel-group, Double Blind, Clinical Trial, to Asses the Safety and Efficacy of Topically Applied FXFM244 Antibiotic Foam in the Treatment of Impetigo
Methods	This is a randomised, parallel-group, double (Investigator, participant)-blind, comparative dose range-finding clinical trial.
Participants	Inclusion criteria of the trial Participants with clinical diagnosis of pure impetigo, impetigo contagiosa, or uncomplicated blistering impetigo Participants 2 years of age or older and in general good health Participants with no less than 2 lesions and no more than 7 lesions (area 0.5 x 0.5 cm) No known medical conditions that, in the Investigator's opinion, could interfere with study participation Participant/participant's guardian (in the case of children) willing and able to comply with all requirements of the protocol Participant/participant's guardian willing and able to give written informed consent prior to participation in the study
Interventions	The study will involve 2 treatment groups. A: Eligible participants will be randomised to receive either FXFM244 - 1% or FXFM244 - 4% in a blinded fashion. Participants will be treated twice daily for 7 days. Following the screening period and baseline visit, study subjects will return at days 3, 7 and 14. At each visit, participants will be evaluated via lesion count, global assessment tolerability, and safety.
Outcomes	Primary outcomes of the trial 1) Decrease in lesion count 7 days Secondary outcomes of the trial 1) The severity of the overall impetigo condition will be measured at baseline and at all follow-up visits. The severity will be assessed and graded based on the scales for Investigator's Global Assessment and bacteriological testing (days 3, 7, and 14)
Starting date	August 2010
Contact information	Foamix Ltd. Lev Yasmin Clinic Natanya, Israel
Notes	This study is probably not eligible for inclusion as 2 dosages of the same drug are used.

---

 

Comparison 1. Non-bullous impetigo: topical (Top) antibiotic (Ab) vs placebo (P)

---

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

---

 1 Cure/improvement

6

575

Risk Ratio (M-H, Random, 95% CI)

2.24 [1.61, 3.13]

---

1.1 Mupirocin

3

173

Risk Ratio (M-H, Random, 95% CI)

2.18 [1.58, 3.00]

---

1.2 Fusidic acid

1

156

Risk Ratio (M-H, Random, 95% CI)

4.42 [2.39, 8.17]

---

1.3 Bacitracin

1

36

Risk Ratio (M-H, Random, 95% CI)

3.71 [0.16, 85.29]

---

1.4 Retapamulin

1

210

Risk Ratio (M-H, Random, 95% CI)

1.64 [1.30, 2.07]

---

 

Comparison 2. Non-bullous impetigo: topical (Top) antibiotic (Ab) vs another topical (Top) antibiotic (Ab)

---

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

---

 1 Cure/improvement

14

Risk Ratio (M-H, Fixed, 95% CI)

Subtotals only

---

1.1 Mupirocin vs rifamycin

1

17

Risk Ratio (M-H, Fixed, 95% CI)

1.72 [0.96, 3.07]

---

1.2 Mupirocin vs neomycin

1

32

Risk Ratio (M-H, Fixed, 95% CI)

1.29 [0.98, 1.71]

---

1.3 Mupirocin vs bacitracin

1

16

Risk Ratio (M-H, Fixed, 95% CI)

2.57 [0.97, 6.80]

---

1.4 Mupirocin vs chlortetracycline

1

14

Risk Ratio (M-H, Fixed, 95% CI)

1.11 [0.78, 1.59]

---

1.5 Mupirocin vs polymyxin B/neomycin

1

8

Risk Ratio (M-H, Fixed, 95% CI)

1.06 [0.56, 2.01]

---

1.6 Fusidic acid vs neomycin/bacitracin

1

84

Risk Ratio (M-H, Fixed, 95% CI)

0.92 [0.66, 1.27]

---

1.7 Fusidic acid vs tetracycline/polymyxin B

1

87

Risk Ratio (M-H, Fixed, 95% CI)

1.06 [0.75, 1.52]

---

1.8 Retapamulin vs fusidic acid

1

517

Risk Ratio (M-H, Fixed, 95% CI)

1.05 [1.00, 1.11]

---

1.9 Sulcanozol vs miconazole

1

66

Risk Ratio (M-H, Fixed, 95% CI)

5.31 [0.66, 43.04]

---

1.10 Hydrocortisone + hydroxyquinoline vs hydrocortisone + miconazole

1

43

Risk Ratio (M-H, Fixed, 95% CI)

2.06 [0.89, 4.76]

---

1.11 Gentamycin vs neomycin

1

128

Risk Ratio (M-H, Fixed, 95% CI)

1.43 [1.03, 1.98]

---

1.12 Mupirocin vs fusidic acid

4

440

Risk Ratio (M-H, Fixed, 95% CI)

1.03 [0.95, 1.11]

---

 

Comparison 3. Non-bullous impetigo: topical (Top) antibiotic (Ab) vs oral (Or) antibiotic (Ab)

---

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

---

 1 Cure/improvement

15

Risk Ratio (M-H, Fixed, 95% CI)

Subtotals only

---

1.1 Mupirocin vs erythromycin

10

581

Risk Ratio (M-H, Fixed, 95% CI)

1.07 [1.01, 1.13]

---

1.2 Mupirocin vs dicloxacillin

1

53

Risk Ratio (M-H, Fixed, 95% CI)

1.04 [0.94, 1.15]

---

1.3 Mupirocin vs cephalexin

1

17

Risk Ratio (M-H, Fixed, 95% CI)

0.95 [0.66, 1.37]

---

1.4 Mupirocin vs ampicillin

1

13

Risk Ratio (M-H, Fixed, 95% CI)

1.78 [0.65, 4.87]

---

1.5 Bacitracin vs erythromycin

1

30

Risk Ratio (M-H, Fixed, 95% CI)

0.5 [0.22, 1.11]

---

1.6 Bacitracin vs penicillin

1

34

Risk Ratio (M-H, Fixed, 95% CI)

0.38 [0.04, 3.25]

---

1.7 Bacitracin vs cephalexin

1

19

Risk Ratio (M-H, Fixed, 95% CI)

0.37 [0.14, 0.95]

---

 2 Cure/improvement

2

137

Risk Ratio (M-H, Random, 95% CI)

1.12 [0.86, 1.46]

---

2.1 Mupirocin vs erythromycin: observer blinded studies

2

137

Risk Ratio (M-H, Random, 95% CI)

1.12 [0.86, 1.46]

---

 

Comparison 4. Non-bullous impetigo: topical (Top) antibiotic (Ab) vs disinfecting treatments (Dt)

---

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

---

 1 Cure/improvement

2

292

Risk Ratio (M-H, Fixed, 95% CI)

1.15 [1.01, 1.32]

---

1.1 Bacitracin vs hexachlorophene

1

36

Risk Ratio (M-H, Fixed, 95% CI)

3.71 [0.16, 85.29]

---

1.2 Fusidic acid vs hydrogen peroxide

1

256

Risk Ratio (M-H, Fixed, 95% CI)

1.14 [1.00, 1.31]

---

 

Comparison 5. Non-bullous impetigo: topical (Top) antibiotic (Ab) vs antifungal (Af)

---

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

---

 1 Cure

1

Risk Ratio (M-H, Fixed, 95% CI)

Totals not selected

---

1.1 Mupirocin vs terbinafine

1

Risk Ratio (M-H, Fixed, 95% CI)

0.0 [0.0, 0.0]

---

 

Comparison 6. Non-bullous impetigo: topical (Top) antibiotic (Ab) + oral (Or) antibiotic (Ab) vs topical (Top) antibiotic (Ab) + oral (Or) antibiotic (Ab)

---

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

---

 1 Cure

1

Risk Ratio (M-H, Fixed, 95% CI)

Totals not selected

---

1.1 Tetracyclin + cefdinir vs tetracyclin + minomycin

1

Risk Ratio (M-H, Fixed, 95% CI)

0.0 [0.0, 0.0]

---

1.2 Tetracyclin + cefdinir vs tetracyclin + fosfomycin

1

Risk Ratio (M-H, Fixed, 95% CI)

0.0 [0.0, 0.0]

---

1.3 Tetracyclin + minomycin vs tetracyclin + fosfomycin

1

Risk Ratio (M-H, Fixed, 95% CI)

0.0 [0.0, 0.0]

---

 

Comparison 7. Non-bullous impetigo: topical (Top) antibiotic (Ab) vs topical (Top) antibiotic (Ab) + oral (Or) antibiotic (Ab)

---

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

---

 1 Cure

1

Risk Ratio (M-H, Fixed, 95% CI)

Subtotals only

---

1.1 Tetracyclin vs tetracyclin + cefdinir

1

34

Risk Ratio (M-H, Fixed, 95% CI)

1.57 [0.69, 3.58]

---

1.2 Tetracyclin vs tetracyclin + minomycin

1

33

Risk Ratio (M-H, Fixed, 95% CI)

0.85 [0.62, 1.15]

---

1.3 Tetracyclin vs tetracyclin + fosfomycin

1

38

Risk Ratio (M-H, Fixed, 95% CI)

1.31 [0.76, 2.25]

---

 

Comparison 8. Non-bullous impetigo: oral (Or) antibiotics (Ab) vs placebo (P)

---

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

---

 1 Cure/improvement

1

Risk Ratio (M-H, Fixed, 95% CI)

Totals not selected

---

1.1 Penicillin

1

Risk Ratio (M-H, Fixed, 95% CI)

0.0 [0.0, 0.0]

---

 

Comparison 9. Non-bullous impetigo: oral (Or) antibiotic (Ab) (cephalosporin) vs another oral (Or) antibiotic (Ab)

---

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

---

 1 Cure/improvement

6

Risk Ratio (M-H, Fixed, 95% CI)

Totals not selected

---

1.1 Cephalexin vs penicillin

1

Risk Ratio (M-H, Fixed, 95% CI)

0.0 [0.0, 0.0]

---

1.2 Cephalexin vs erythromycin

1

Risk Ratio (M-H, Fixed, 95% CI)

0.0 [0.0, 0.0]

---

1.3 Cephalexin vs azithromycin

1

Risk Ratio (M-H, Fixed, 95% CI)

0.0 [0.0, 0.0]

---

1.4 Cefaclor vs azithromycin

1

Risk Ratio (M-H, Fixed, 95% CI)

0.0 [0.0, 0.0]

---

1.5 Cefaclor vs amoxicillin/clavulanic acid

1

Risk Ratio (M-H, Fixed, 95% CI)

0.0 [0.0, 0.0]

---

1.6 Cefadroxil vs penicillin

1

Risk Ratio (M-H, Fixed, 95% CI)

0.0 [0.0, 0.0]

---

1.7 Cefadroxil vs flucloxacillin

1

Risk Ratio (M-H, Fixed, 95% CI)

0.0 [0.0, 0.0]

---

 

Comparison 10. Non-bullous impetigo: oral (Or) cephalosporin vs other oral (Or) cephalosporin

---

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

---

 1 Cure/improvement

7

Risk Ratio (M-H, Fixed, 95% CI)

Subtotals only

---

1.1 Cephalexin vs cefadroxil

1

96

Risk Ratio (M-H, Fixed, 95% CI)

0.99 [0.88, 1.12]

---

1.2 Cephalexin vs cefdinir

3

201

Risk Ratio (M-H, Fixed, 95% CI)

0.95 [0.88, 1.03]

---

1.3 Cefaclor vs cefdinir

1

13

Risk Ratio (M-H, Fixed, 95% CI)

0.64 [0.23, 1.82]

---

1.4 Cefditoren vs cefuroxime

1

58

Risk Ratio (M-H, Fixed, 95% CI)

0.73 [0.55, 0.97]

---

1.5 Cefditoren vs cefadroxil

1

74

Risk Ratio (M-H, Fixed, 95% CI)

1.02 [0.78, 1.33]

---

 

Comparison 11. Non-bullous impetigo: oral (Or) macrolide vs penicillin

---

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

---

 1 Cure/improvement

7

363

Risk Ratio (M-H, Fixed, 95% CI)

1.06 [0.98, 1.15]

---

1.1 Erythromycin vs penicillin V

2

79

Risk Ratio (M-H, Fixed, 95% CI)

1.29 [1.07, 1.56]

---

1.2 Erythromycin vs dicloxacillin

1

58

Risk Ratio (M-H, Fixed, 95% CI)

1.03 [0.94, 1.13]

---

1.3 Erythromycin vs amoxicillin

1

129

Risk Ratio (M-H, Fixed, 95% CI)

1.00 [0.89, 1.13]

---

1.4 Azithromycin vs cloxacillin

1

16

Risk Ratio (M-H, Fixed, 95% CI)

1.4 [0.57, 3.43]

---

1.5 Azithromycin vs flucloxacillin/dicloxacillin

1

39

Risk Ratio (M-H, Fixed, 95% CI)

0.84 [0.61, 1.16]

---

1.6 Clindamycin vs dicloxacillin

1

42

Risk Ratio (M-H, Fixed, 95% CI)

1.01 [0.80, 1.27]

---

 

Comparison 12. Non-bullous impetigo: oral (Or) macrolide vs another oral (Or) macrolide

---

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

---

 1 Cure/improvement

1

Risk Ratio (M-H, Fixed, 95% CI)

Totals not selected

---

1.1 Azithromycin vs erythromycin

1

Risk Ratio (M-H, Fixed, 95% CI)

0.0 [0.0, 0.0]

---

 

Comparison 13. Non-bullous impetigo: oral (Or) penicillin vs other oral (Or) antibiotic (Ab) (including penicillin)

---

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

---

 1 Cure/improvement

4

Risk Ratio (M-H, Random, 95% CI)

Subtotals only

---

1.1 Amoxicillin + clavulanic acid vs amoxicillin

1

44

Risk Ratio (M-H, Random, 95% CI)

1.4 [1.04, 1.89]

---

1.2 Amoxicillin + clavulanic acid vs fleroxacin

1

42

Risk Ratio (M-H, Random, 95% CI)

1.14 [0.80, 1.62]

---

1.3 Cloxacillin vs penicillin

2

166

Risk Ratio (M-H, Random, 95% CI)

1.59 [1.21, 2.08]

---

 

Comparison 14. Non-bullous impetigo: other comparisons of oral (Or) antibiotics (Ab)

---

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

---

 1 Cure/improvement

2

Risk Ratio (M-H, Fixed, 95% CI)

Totals not selected

---

1.1 Lomefloxacin vs norfloxacin

1

Risk Ratio (M-H, Fixed, 95% CI)

0.0 [0.0, 0.0]

---

1.2 Fusidic acid vs pristinamycin

1

Risk Ratio (M-H, Fixed, 95% CI)

0.0 [0.0, 0.0]

---

 

Comparison 15. Non-bullous impetigo: oral (Or) antibiotics (Ab) vs disinfecting treatments (Dt)

---

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

---

 1 Cure/improvement

1

Risk Ratio (M-H, Fixed, 95% CI)

Totals not selected

---

1.1 Penicillin vs hexachlorophene

1

Risk Ratio (M-H, Fixed, 95% CI)

0.0 [0.0, 0.0]

---

 

Comparison 16. Bullous impetigo: topical (Top) antimicrobial vs placebo (P)

---

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

---

 1 Cured/improved after 3 to 4 days

1

Risk Ratio (M-H, Fixed, 95% CI)

Totals not selected

---

1.1 Eksalb vs placebo

1

Risk Ratio (M-H, Fixed, 95% CI)

0.0 [0.0, 0.0]

---

 

Comparison 17. Bullous impetigo: topical (Top) antibiotic (Ab) vs another topical (Top) antibiotic (Ab)

---

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

---

 1 Cure/improvement

1

Risk Ratio (M-H, Fixed, 95% CI)

Totals not selected

---

1.1 Fusidic acid vs neomycin/bacitracin

1

Risk Ratio (M-H, Fixed, 95% CI)

0.0 [0.0, 0.0]

---

1.2 Fusidic acid vs chloramphenicol

1

Risk Ratio (M-H, Fixed, 95% CI)

0.0 [0.0, 0.0]

---

1.3 Chloramphenicol vs neomycin/bacitracin

1

Risk Ratio (M-H, Fixed, 95% CI)

0.0 [0.0, 0.0]

---

 

Comparison 18. Bullous impetigo: topical (Top) antibiotic (Ab) vs oral (Or) antibiotic (Ab)

---

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

---

 1 Cure/improvement

1

Risk Ratio (M-H, Fixed, 95% CI)

Subtotals only

---

1.1 Fusidic acid vs erythromycin

1

24

Risk Ratio (M-H, Fixed, 95% CI)

1.43 [0.83, 2.45]

---

1.2 Neomycin/bacitracin vs erythromycin

1

24

Risk Ratio (M-H, Fixed, 95% CI)

0.14 [0.02, 0.99]

---

1.3 Chloramphenicol vs erythromycin

1

24

Risk Ratio (M-H, Fixed, 95% CI)

0.29 [0.07, 1.10]

---

 

Comparison 19. Bullous impetigo: oral (Or) antibiotic (Ab) vs another oral (Or) antibiotic (Ab)

---

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

---

 1 Cure/improvement

1

Risk Ratio (M-H, Fixed, 95% CI)

Totals not selected

---

1.1 Cephalexin vs dicloxacillin

1

Risk Ratio (M-H, Fixed, 95% CI)

0.0 [0.0, 0.0]

---

 

Comparison 20. Secondary impetigo: topical (Top) antibiotic (Ab) vs oral (Or) antibiotic (Ab)

---

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

---

 1 Cure/improvement

1

Risk Ratio (M-H, Fixed, 95% CI)

Totals not selected

---

1.1 Mupirocin calcium vs cephalexin

1

Risk Ratio (M-H, Fixed, 95% CI)

0.0 [0.0, 0.0]

---

 

Comparison 21. Secondary impetigo: steroid (S) vs antibiotic (Ab)

---

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

---

 1 Cure/improvement

1

Risk Ratio (M-H, Fixed, 95% CI)

Totals not selected

---

1.1 Betamethasone vs gentamycin

1

Risk Ratio (M-H, Fixed, 95% CI)

0.0 [0.0, 0.0]

---

 

Comparison 22. Secondary impetigo: steroid (S) + antibiotic (Ab) vs steroid (S)

---

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

---

 1 Cure/improvement

1

Risk Ratio (M-H, Fixed, 95% CI)

Totals not selected

---

1.1 Betamethasone + gentamycin vs betamethasone

1

Risk Ratio (M-H, Fixed, 95% CI)

0.0 [0.0, 0.0]

---

 

Comparison 23. Secondary impetigo: steroid (S) + antibiotic (Ab) vs antibiotic (Ab)

---

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

---

 1 Cure/improvement

1

Risk Ratio (M-H, Fixed, 95% CI)

Totals not selected

---

1.1 Betamethasone + gentamycin vs gentamycin

1

Risk Ratio (M-H, Fixed, 95% CI)

0.0 [0.0, 0.0]

---

 

Comparison 24. Secondary impetigo: oral (Or) antibiotic (Ab) vs another oral (Or) antibiotic (Ab)

---

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

---

 1 Cure/improvement

1

Risk Ratio (M-H, Fixed, 95% CI)

Totals not selected

---

1.1 Cephalexin vs enoxacin

1

Risk Ratio (M-H, Fixed, 95% CI)

0.0 [0.0, 0.0]

---

 

Table 1. Adverse events

---

Study	Adverse events: nature and number or percentage by treatment group
Arata 1989a; Arata 1989b	mainly gastrointestinal: cefdinir 9/142, cefaclor 4/145
Arredondo 1987	mupirocin: nil reported dicloxacillin: abdominal pain 1/ 31, vomiting 2/31
Barton 1987	not reported
Barton 1988	abdominal pain: erythromycin 1/ 49, dicloxacillin 1/51 vomiting + rash: dicloxacillin 1/51
Barton 1989	gastrointestinal: erythromycin 8/48, mupirocin 4/49
Bass 1997	not reported
Beitner 1996	diarrhoea: cefadroxil 14/327, flucloxacillin 87/324 (all participants) severe (stomach ache/rash/fever/vomiting): cefadroxil 14/327, flucloxacillin 2/234 (all participants)
Blaszcyk 1998	mainly gastro-intestinal (half of which were considered treatment-related): clindamycin 150 mg (19%), clindamycin 300 mg (17%), dicloxacillin 10% (all participants)
Britton 1990	minor gastrointestinal: 11 total, equally divided
Bucko 2002a; Bucko 2002b	unclear and not specified for impetigo participants
Christensen 1994	led to withdrawal: skin irritation 1, burning 1, blistering 1 (all fusidic acid - hydrogen peroxide: 0) mild SE: fusidic acid 9, hydrogen peroxide 13
Ciftci 2002	burning, stinging, itching: 1 in each group rash: 1 in terbinafine group
Claudy 2001	upper gastrointestinal: fusidic acid 6.8% vs pristinamycin 11.6% lower gastrointestinal: 2.5% vs 16.7% hypersensibility: 1.9% vs 5.8%
Dagan 1989	vomiting: amoxicillin 1, amoxicillin and clavulanic acid (augmentin) 0 diarrhoea: amoxicillin 1, amoxicillin and clavulanic acid (augmentin) 0
Dagan 1992	gastrointestinal: erythromycin 11/47, mupirocin 4/51
Daniel 1991a; Daniel 1991b	no subgroup data
Demidovich 1990	nil reported
Dillon 1983	not reported
Dux 1986	pruritus: mupirocin 1/78 nausea and abdominal pain: erythromycin 1/50, cloxacillin 0/20 (all participants)
Eells 1986	not reported
Esterly 1991	mupirocin: nil reported erythromycin: stomach pain and nausea 1/20, vomiting and irritability 1/20, hysterical attacks 1/20
Farah 1967	not reported
Faye 2007	diarrhoea: amoxicillin 2/64 vs erythromycin 11/65
Fujita 1984	mainly gastrointestinal: enoxacin 11/113, cephalexin 4/110 (all participants)
Gilbert 1989	nil reported
Ginsburg 1978	1 child removed from cefadroxil group because of vomiting; no other SE reported
Giordano 2006	diarrhoea: cefdinir 10% vs cephalexin 4% nausea: cefdinir 3% vs cephalexin 6% vaginal mycose of females: cefdinir 3% vs cephalexin 6%
Goldfarb 1988	mild diarrhoea: amupirocin 0/30, erythromycin 5/30
Gonzalez 1989	not reported
Gould 1984	not reported
Gratton 1987	mostly gastrointestinal: erythromycin 8/29 mupirocin: nil reported
Hains 1989	nil reported
Ishii 1977	nil reported
Jaffe 1985	mild diarrhoea: Augmentin® 2/18, cefaclor 5/16 (all participants)
Jaffe 1986	mild staining: hydrocortisone + potassium hydroxyquinoline sulphate cream 2/24, 1% hydrocortisone + 2% miconazole nitrate cream 0/24
Kennedy 1985	nil reported
Kiani 1991	mainly gastrointestinal: azithromycin 30/182, cephalexin: 20/184 Withdrawn: azithromycin 5 (4 gastrointestinal; 1 dizziness and somnolence), cephalexin 1(euphoria) (all participants)
Koning 2003	mainly pain and burning due to povidone iodine: fusidic acid 7/76, placebo 19/80
Koning 2008	any: retapamulin 15/139 vs placebo 2/71 application site pruritis: 9 vs 1
Koranyi 1976	mild abdominal cramps: erythromycin 2/15, bacitracin 0/15
Kuniyuki 2005	not reported
McLinn 1988	gastrointestinal: mupirocin 0/30, erythromycin 6/30
Mertz 1989	nil reported
Montero 1996	mild skin side-effects: azythromycin 3/100, cefaclor 2/100
Moraes Barbosa 1986	not reported
Morley 1988	all local skin reactions: sodium fusidate 2/191, mupirocin 12/163 (all participants)
Nolting 1988	mild burning: sulconazole 0/32, miconazole 1/34
Oranje 2007	local irritation: retapamulin 6/346 vs sodium fusidate 0/173
Pruksachat 1993	not reported
Rice 1992	stomach ache/diarrhoea/vomiting/itching/burning (%): erythromycin 24/10/7/5/0, mupirocin 2/2/0/12/10
Rist 2002	diarrhoea: mupirocin 2/82 vs cephalexin 3/77
Rodriguez-Solares 1993	gastrointestinal: azithromycin 2/25, dicloxacillin/flucloxacillin 2/14
Rojas 1985	nausea/vomiting: mupirocin 0/52, vehicle 1/52
Ruby 1973	not reported
Sutton 1992	local: fusidic acid 2/104, mupirocin 4/97
Tack 1997	mainly gastrointestinal: cefdinir 16%, cephalexin 11% (all participants)
Tack 1998	no subgroup data was available; it included only participants that had pathogens susceptible to both study drugs
Tamayo 1991	nil reported
Tassler 1993	mainly gastrointestinal: fleroxacin 17%, amoxicillin/clavunalate 21% (all participants)
Vainer 1986	total 3% skin rash: fusidic acid 1/43 burning and itching: tetracycline/polymyxin B ointment and neomycin/bacitracin ointment both 1/44 and 1/41 respectively
Wachs 1976	not reported
Wainscott 1985	nil reported
Welsh 1987	nil reported
White 1989	minor itching or burning: mupirocin 6/263, fusidic acid 2/127 (all participants)
Wilkinson 1988	rash: mupirocin 0/24, neomycin 1/26 (all participants)

---

 

Table 2. Declared sponsorship or funding

---

Study	Sponsor (product)
Barton 1987	Fleur de Lis Foundation
Barton 1988	Warner-Lambert Corporation
Barton 1989	Warner- Lambert Corporation
Beitner 1996	Bristol-Myers Squibb (cefadroxil)
Blaszcyk 1998	Pharmacia & Upjohn Asia (clindamycin)
Britton 1990	US Navy Bureau of Medicine and Surgery Clinical Investigation Program
Bucko 2002a, Bucko 2002b	TAF Pharmaceutical Products (cefditoren)
Daniel 1991a; Daniel 1991b	Pfizer Central Research (azithromycin)
Dillon 1983	Eli Lilly Research (cephalexin)
Giordano 2006	Abott Laboratories (cefdinir)
Goldfarb 1988	Beecham Laboratories (mupirocin)
Hains 1989	Bristol-Myers Squibb (cefadroxil)
Jaffe 1985	Beecham Laboratories (amoxicillin+clavulanic acid)
Koning 2003	Dutch College of General Practitioners
Koning 2008	GlaxoSmithKline (retapamulin)
Mertz 1989	Beecham Laboratories (mupirocin)
Oranje 2007	GlaxoSmithKline (retapamulin)
Rist 2002	GlaxoSmithKline (mupirocin)
Sutton 1992	Leo Laboratories (fusidic acid)
Tack 1997	Parke-Davis pharmaceutical research (cefdinir)
Tack 1998	Parke-Davis pharmaceutical research (cefdinir)
Wainscott 1985	Beecham Pharmaceuticals (mupirocin)
White 1989	Beecham Pharmaceuticals (mupirocin)

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