Evaluation of the effect of topical cefadroxil on bacterial load of pathogenic staphylococci in anterior nares in human volunteers, comparative study between oral vs. topical cefadroxil and evaluation of effect of combination of oral plus topical cefadroxil in patients with staphylococcal superficial skin infections

Tanvi B. Shah, Dimple S. Mehta, Hiral A. Shah, Sanjay J. Mehta, Jayendra N. Dave


Background: Cefadroxil has good tissue penetration & exerts more sustained action at the site of infection after oral absorption. Our aim of the study was to check topical cefadroxil has any efficacy over staphylococcal superficial skin infection or not.

Methods: Pre-treatment nasal swabs were obtained from 25 healthy human volunteers and bacterial load was recorded. After single application of topical cefadroxil 3% in left anterior nare and placebo (vehicle) in right anterior nare nasal swabs were obtained and results were compared. 150 patients with staphylococcal superficial skin infections were distributed in 4 groups: Group A - oral cefadroxil 500 mg twice daily for 5 days, Group B - topical cefadroxil (0.5 % to 5%) twice daily, Group C - cefadroxil 500 mg orally plus placebo (vehicle) topically twice daily and Group D -cefadroxil 500 mg orally plus cefadroxil preparation topically twice daily. Bacterial load was measured before treatment, on follow up &after clinical cure and results were compared.

Results: Topical cefadroxil significantly reduced bacterial load after single application in anterior nare. Topical cefadroxil cured and significantly reduced bacterial load in staphylococcal superficial skin infections within 3 days of treatment. Oral plus topical cefadroxil combination therapy significantly reduced bacterial load and cured infection within 3 days of treatment in patients with moderate to heavy bacterial growth. No any adverse effect was observed during entire study period in any of groups.

Conclusions: Topical preparation of cefadroxil is safe and effective in treating staphylococcal superficial skin infections. Combination of oral plus topical cefadroxil showed synergistic effect in infections with moderate to heavy growth. This study is registered at CTRI [REG ID: CTRI/2013/02/003433 REF: REF/2013/02/004576].


Staphylococcal superficial skin infections, Cefadroxil

Full Text:



White A. Increased infection rates in heavy nasal carriers of coagulase-positive staphylococci. Antimicrob Agents Chemother 1963;161:667-70.

Boelaert JR. S. aureus infection in hemodialysis patients. Mupirocin as a topical strategy against nasal carriage: a review. J Chemother 1994;6 Suppl 2:19-24.

Davies SJ, Ogg CS, Cameron JS, Poston S, Noble WC. S. aureus nasal carriage, exit-site infections and catheter loss in patients treated with continuous ambulatory peritoneal dialysis (CAPD). Peritoneal Dial Int 1989;9:61-4.

Schaberg DR, Culver DH, Gaynes RP. Major trends in the microbial etiology of nosocomial infection. Am J Med 1991;91:725-55.

Reagan DR, Doebbeling BN, Pfaller MA, Sheetz CT, Houston AK, Hollis RJ, et al. Elimination of coincident S. aureus nasal and hand carriage with intranasal application of mupirocin calcium ointment. Ann Intern Med 1991;114:101-6.

Tripathi KD, Beta-Lactam Antibiotics. Essentials of medical pharmacology; 6th ed. New Delhi: Jaypee Brothers; 2008. p. 705.

Shah TB. Evaluation of safety, efficacy and cost effectiveness of topical cefadroxil plus comparative study of oral v/s topical cefadroxil in staphylococcal superficial skin infections [PG thesis]. Saurashtra University; 2010.

Goldfarb J, Crenshaw D, O'Horo J. Randomized clinical trial of topical mupirocin versus oral erythromycin for impetigo. Antimicrob Agents Chemother 1988;22:1780-3.

McLinn S. A bacteriologically controlled, randomized study comparing the efficacy of 2% mupirocin ointment (Bactroban) with oral erythromycin in the treatment of patients with impetigo. J Am Acad Dermatol 1990;22:883-5.

Barton LL, Freidman AD, Sharkey AM. Impetigo contagiosa III. Comparative efficacy of oral erythromycin and topical mupirocin. Pediatr Dermatol 1989;6:134-8.

Mertz PM, Marshall DA, Eaglestein WH. Topical mupirocin treatment of impetigo is equal to oral erythromycin therapy. Arch Dermatol 1989;125:1069-73.

Britton JW, Fajardo JE, Krafte JB. Comparison of mupirocin and erythromycin in the treatment of impetigo. J Pediatr 1990;117:827-9.

Dagan R, Bar DY. Double-blind study comparing erythromycin and mupirocin for treatment of impetigo in children. Antimicrob Agents Chemother 1992;26:287-90.

Rice TD, Duggan AK, DeAngelis C. Cost effectiveness of erythromycin versus mupirocin for the treatment of impetigo in children. Pediatrics 1992;89:210-4.

Roy AK, Ghosh SK, Ganguli U, Basak S, Banatwalla KS, Basu S. Comparative evaluation of sodium fusidate cream in common pyodermas with topical gentamicin ointment and systemic antibiotics. Ind J Dermatol 1996;41:89-92.

Bass JW, Chan DS, Creamer KM. Comparison of oral cephalexin, topical mupirocin and topical bacitracin for treatment of impetigo. Pediatr Infect Dis J 1997;16:708-10.

Williams REO. Healthy carriage of Staphylococcus aureus: its prevalence and importance. Bacteriol Rev 1963;27:56-71.

Forbes BA, Sahm DF, Weissfeld AS. Specimen management. Bailey & Scott’s Diagnostic Microbiology. 12th ed. Mosby Elsevier 2007. p.75.

Long CC, Finlay AY. The fingertip unit: a new practical measure. Clin Exp Dermatol 1991;16:444-7.

Williams RE. Skin and nose carriage of bacteriophage types of Staphylococcus aureus. J Pathol Bacteriol 1946;58:259-68.

Nagmoti MJ, Patil CS, Metgud SC. A bacterial study of pyoderma in Belgaum. Indian J Dermatol Venereol Leprol 1999;65:69-71.

Tulloch LG. Nasal carriage in staphylococcal skin infections. Br Med J 1954;2:912-3.

Welsh O, Saenz C. Topical mupirocin compared with oral ampicillin in the treatment of primary and secondary skin infections. Curr Ther Res 1987;41:114-20.

Park SW, Wang HY, Sung HS. A study for the isolation of the causative organism, antimicrobial susceptibility tests and therapeutic aspects in patients with impetigo. Korean J Dermatol 1993;31:312-9.

Koranyi KI, Burech DL, Haynes RE. Evaluation of bacitracin ointment in the treatment of impetigo. Ohio Stat Med J 1976;72:368-70.

Ruby RJ, Nelson JD. The influence of hexachlorophene scrubs on the response to placebo or penicillin therapy in impetigo. Pediatrics 1973;52:854-9.

Moraes Barbosa AD. Comparative study between topical 2% sodium fusidate and oral association of chloramphenicol/neomycin/bacitracin in the treatment of staphylococcic impetigo in new-born. Arq Bras Med 1986;60:509-11.