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Etiology and Therapy of Impetigo: Reconsidered

Am J Dis Child. 1990;144(3):274. doi:10.1001/archpedi.1990.02150270020018.
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Sir.—We read with interest the article by Dagan and Bar-David1 in the August 1989 issue of AJDC. Despite the authors' assertion that there were no previous blind studies comparing "a regimen active against both staphylococci and streptococci vs a regimen active against streptococci only," we have published the results of investigations of 268 patients with impetigo that were performed during the last 3 years.2-4

More than 50% of our patients had Staphylococcus aureus alone, and an additional 25% had S aureus in association with group A β-hemolytic streptococci isolated from their skin lesions. Fewer than 10% of the patients had group A β-hemolytic streptococci as their sole lesion isolate. Although more than 90% of isolates of S aureus were resistant to penicillin in vitro, only 14% were resistant to erythromycin in vitro. In our first study comparing oral penicillin treatment and erythromycin treatment, there was a 27%


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