Sir.—Dagan and Bar-David1 recently provided further evidence that Staphylococcus aureus is a common pathogen in nonbullous impetigo. In this study, the authors chose two antibiotics (amoxicillin and amoxicillin plus clavulinic acid) that are not commonly recommended as the drugs of choice for treatment of group A β-hemolytic streptococcal or S aureus disease.2,3 In regard to impetigo, both drugs have significant, unnecessary gram-negative coverage that increases the risk for adverse side effects and the emergence of resistant organisms. A more appropriate comparison would involve penicillin with a semisynthetic penicillin or a first-generation cephalosporin.
The conclusion that "a drug with an antimicrobial spectrum that includes S aureus is indicated" in nonbullous impetigo is well taken; however, it is equally important to prevent potentially adverse consequences from the choice of an unnecessarily broad spectrum drug in the treatment of this common childhood illness.
BRONFIN DR. Increasing the Antibiotic Spectrum in the Treatment of Impetigo. Am J Dis Child. 1990;144(3):274. doi:10.1001/archpedi.1990.02150270020017