Oral Clindamycin as Drug of Choice for Scabies Patients with Secondary Bacterial Infections in West Java, Indonesia

The aim of this study was to identify the causative secondary bacterial infection in scabies and its susceptibility against systemic antimicrobials. We performed a cross-sectional descriptive study of 34 scabies patients clinically diagnosed by investigators through consecutive sampling in one District Hospital in West Java, Indonesia from January to March 2017. The secondary bacterial infection was confirmed by Gram staining. Bacterial culture was derived from intact pustules, then identified using Vitek® 2 system, including its susceptibility against 30 systemic antimicrobials. The result of bacterial identification consisted of 48.89% Group A Beta-Hemolytic Streptococcus (GABHS), 44.44% Staphyloccocus aureus (S. aureus), 4.44% Staphylococcus epidermidis (S. epidermidis) and 2.22% Klebsiella pneumoniae (K. Pneumoniae). All bacterias were sensitive to carbapenem group, however resistant to cephradine and kanamycin. The overall percentages of GABHS sensitivity to the tested antibiotics were as follows: 95.45% for chloramphenicol and ceftriaxone, 90.91% for amoxicillin/clavulanate, 86.36% for clindamycin, cloxacillin, cefotaxime, 72.27% for ciprofloxacin and methicillin. Sensitivity of S. aureus to the antibiotics were as follows: 100.00% for methicillin, 95.00% for clindamycin and cloxacillin, 90.00% for ciprofloxacin and levofloxacin, 85.00% for cotrimoxazole and 75.00% for ceftriaxone. The sensitivity of S. epidermidis to clindamycin, amoxicillin/clavulanate and methicillin were 100.00%. All of K. pneumoniae (100.00%) were sensitive to ciprofloxacin, cotrimoxazole, ampicillin/sulbactam, cefazolin, ceftriaxone, ceftazidime and cefepime. The most common etiology of secondary infection in scabies were GABHS and S. aureus with varying sensitivity and oral clindamycin is a drug of choice which can be given to pediatric or adults patients.