In Reply.—I am sorry that we missed the report by Dagan and Bar-David. It was published a few months before our study was submitted for publication, so we did not find it in our review. We did cite two other recent studies from the southeastern and southwestern United States that showed, along with our study, that penicillin-resistant Staphylococcus aureus is emerging as the major pathogen implicated as the cause of impetigo in diverse areas of the United States. The report by Dagan and Bar-David, along with an extensive review of the cause of impetigo from numerous other reports summarized by Esterly et al1 in a more recent issue of AJDC, confirms that this is a worldwide phenomenon. From these observations, it may be concluded that penicillin is no longer adequate for primary treatment of impetigo in most areas of the world.
BASS JW. Staphylococcus aureus in Impetigo-Reply. Am J Dis Child. 1991;145(11):1223. doi:10.1001/archpedi.1991.02160110013005