Randomised controlled trial (RCT) comparing three different treatments for mild to moderate impetigo in children

Can hydrogen peroxide cream be at least as effective as the increasingly antibiotic-resistant conventional treatment, fusidic acid?

Dr Alison Leversha
University of Auckland

What is the problem and who does it affect?

Serious skin infections have been among the top three reasons for admission to Starship and KidzFirst hospitals over the last 15 years. The effects are disproportionately borne by Pacific and Maori children, who are four – five times, and two – three times, more likely respectively to be admitted with serious skin infections than European children.

Skin infections are among the most common health issues affecting children in low decile schools, with increasing concern of the impact on school attendance and subsequent educational problems. The most common skin infection in schools is impetigo or ‘school sores’, affecting close to a third of children in schools in socioeconomically disadvantaged communities.

Currently, impetigo is treated with fusidic acid – an antibiotic cream applied to the surface of the skin. However, bacterial resistance to this medication is now approaching 30 percent causing concern about its ongoing use contributing to further antibiotic resistance. It is therefore necessary that alternative treatment options be examined.


What is the intervention hoping to achieve?

Dr Leversha, from Auckland’s Starship Children’s Hospital, will undertake an intervention which will recruit 480 children, aged five -13, who present with school sores at school-based health clinics. Dr Leversha will compare fusidic acid with an alternative treatment, hydrogen peroxide cream, applied to the skin infection, while also assessing these against simple wound care to help further illustrate potential benefits.

If successful, the results of the study will inform evidence-based skin infection guidelines locally, nationally and internationally.