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The skin sore trial : exploring a better treatment option for impetigo in Indigenous children living in remote Australia

Bowen, Asha (2014). The skin sore trial : exploring a better treatment option for impetigo in Indigenous children living in remote Australia. PhD Thesis, Charles Darwin University.

Document type: Thesis
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Author Bowen, Asha
Title The skin sore trial : exploring a better treatment option for impetigo in Indigenous children living in remote Australia
Institution Charles Darwin University
Publication Date 2014
Thesis Type PhD
Abstract Impetigo is prevalent among Australian Indigenous children living in the Northern Territory. The cause of this endemic skin infection is multifactorial including household overcrowding, poverty, endemic scabies and fungal skin infections, tropical climate, insect bites and minor trauma. Although impetigo is widespread, affecting up to 50% of children in a community at one time, care seeking for treatment of impetigo does not reflect this burden accurately, possibly due to awareness of the painful injection prescribed. A better treatment is needed.

This thesis presents the first randomised controlled trial conducted amongst remote living Indigenous Australian children on the treatment of extensive impetigo, and one of the largest impetigo trials worldwide. Methodological gaps were addressed, with studies published on the susceptibility of Streptococcus pyogenes to trimethoprim-sulphamethoxazole (SXT), the transport of impetigo swabs in remote settings and photography protocols for capturing and scoring sores. The principal findings are:

1. Either of two short courses of SXT are non-inferior to standard treatment of impetigo with intramuscular benzathine penicillin G (BPG) – published in The Lancet;

2. S. pyogenes remains the key driver of impetigo in our region; and

3. S. pyogenes is susceptible in vitro to SXT, and SXT is effective in vivo for the treatment of skin infections caused by S. pyogenes.

These findings will inform the management of children with impetigo in remote Indigenous communities and have already been incorporated into treatment algorithms and guidelines regionally and nationally. This provides a simple, short-course antibiotic regimen that is palatable, inexpensive and has a low side effect profile, as an alternative to an injection of intramuscular penicillin, which has been the standard of care for more than 20 years. Ongoing surveillance will be needed to understand how this new regimen is utilised and whether widespread use for a common condition will alter antibiotic resistance profiles.
Additional Notes Please note that some articles in the thesis are available in hard copy only.

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