Authors:
Tasani M, Tong SYC, Andrews RM, Holt DC, Currie BJ, Carapetis JR, Bowen AC.
Authors notes:
Pediatric Infectious Disease Journal. 2016;35(4):347-78.
Keywords:
Impetigo prevalence, Impetigo demographics, Impetigo treatment, Scabies, co-infection, Indigenous children, remote communities, Australia
Abstract:
BACKGROUND:: Skin infections account for a high disease burden in Indigenous children living in northern Australia.
Although the relationship between impetigo and scabies is recognised, the prevalence of scabies in children with impetigo is not well reported.
We report the prevalence, demographics and treatment success outcomes of impetigo and scabies co-infection in Indigenous children who were participants in a randomized controlled trial of impetigo treatment conducted in remote communities of the Northern Territory, Australia.
METHODS:: Of 1715 screening episodes for impetigo, 508 children were randomized to receive intramuscular benzathinebenzylpenicillin (BPG), twice daily co-trimoxazole (SXT) for 3 days (4mg/kg trimethoprim plus 20mg/kg sulphamethoxazole per dose) or once daily co-trimoxazole (SXT) for 5 days (8mg/kg trimethoprim plus 40 mg/kg sulphamethoxazole per dose).
A clinical diagnosis of scabies, tinea of the skin, scalp or nail, and head lice was made on all children.
Scabies presence was not confirmed using diagnostic scrapings.
In a post-hoc analysis, we determined whether co- infection with scabies had an impact on treatment success for impetigo.
FINDINGS:: Of children randomized to receive treatment for impetigo, 84/508 (16.5%) had scabies.
The presence of scabies ranged from 14.3% to 20.0% in the three treatment groups.
Treatment success for impetigo with and without scabies co-infection, independent of the treatment groups, was 75.9% and 86.6% respectively, absolute difference 10.7%.
Treatment success for impetigo with and without scabies co-infection in the BPG group was 69.6% and 88.0% respectively, absolute difference 18.4%.
In the pooled SXT groups the treatment success for impetigo with and without scabies co-infection was 78.6% and 86.0% with absolute difference 7.4%.
Treatment success in the pooled SXT group with scabies (78.6%) was higher than in the BPG group (69.6%) with scabies, absolute difference 9.0%.
Prediction of treatment success for impetigo is dependent on the presence or absence of scabies and for scabies co-infected impetigo it was higher in the group treated with SXT.
CONCLUSIONS: The burden of scabies in an impetigo trial for Indigenous children was high.
Treatment success for scabies co-infection was lower than for impetigo overall, with a higher success seen in the co-trimoxazole group than the benzylpenicillin group.