Oral amoxicillin vs. oral erythromycin in the treatment of pyoderma in Bamako, Mali: an open randomized trial.

BACKGROUND: Pyoderma (bacterial superficial skin infection) is an extremely common disorder in tropical developing countries. In these settings, Streptococcus pyogenes is considered to be the main etiological agent. Apart from epidemics of poststreptococcal glomerulonephritis where mass treatment with intramuscular benzathine-penicillin is recommended, no recommendation exists for the treatment of pyoderma in this setting. The aim of this study was to evaluate the efficacy of oral amoxicillin in the treatment of pyoderma in Mali, by comparison with oral erythromycin. METHODS: In Bamako, 132 patients with pyoderma, diagnosed and graded as "severe" on clinical grounds, were randomly assigned to an oral treatment by either amoxicillin (50 mg/kg per day) or erythromycin; infections of the follicular appendage were excluded. Both drugs were associated with the topical application of povidone iodine. The patients were evaluated openly at the seventh day of treatment for cure or marked improvement of the clinical features, indicating successful treatment. RESULTS: Three patients were lost to follow-up. Treatment was successful in 57 of 64 patients treated with amoxicillin vs. 58 of 65 patients treated with erythromycin (P = 0.00). CONCLUSIONS: Amoxicillin was as efficacious as erythromycin in the treatment of severe pyoderma in Mali. Owing to its efficacy, added to high availability and low cost, this compound should be considered a first-line treatment of this disorder in this country, and perhaps in other countries where this condition presents in a similar way.