Background: Impetigo is a bacterial skin infection. It causes red sores that can break open, ooze fluid, and develop a yellow-brown crust.1 These sores can occur anywhere on the body. It is one of the most common skin infections in children. Topical antibiotics are the treatment of choice for most cases of impetigo, exposure to antibiotics leads to the selection of resistant bacteria. An inappropriate antibiotic treatment will lead to a further increase of AMR. Apple cider vinegar contains polyphenolic compounds that have beneficial health effects. Apple cider vinegar contains acetic acid, polyphenols, pectin, and carotenoids with antibacterial and prebiotic properties. In vitro studies revealed that apple cider vinegar also shows antimicrobial activity against group A β-hemolytic streptococci or Staphylococcus aureus which is the commonest bacterial cause Impetigo.  

Objectives: The study aimed to evaluate the efficacy, to determine the record incidence of adverse effect and to compare the cure rates of Apple Cider Vinegar 5 % in Cream Form versus Mupirocin 2% Cream in the Treatment of Impetigo and Folliculitis. The main outcome measurements of the trial were clinical cure from Skin Infection Rating Scale. Secondary measures were the adverse reaction reported on the area of application and treatment tolerance. Global physician assessment was also evaluated and the end of 1st and 2nd weeks.                   

Methods: Apple Cider Vinegar 5 % in Cream and Mupirocin 2% Cream was packaged in amber bottles. This is a single blind randomized clinical trial using two type of topical treatment. The treatment consisted of twice daily application of Apple Cider Vinegar 5 % cream and twice daily application of Mupirocin 2% cream on different subject. From the baseline visit, treatment effectiveness and patient tolerance were evaluated at two follow up visits (weeks 1 and 2).

Results:  There were 78 subjects were included in the study. After two weeks of treatment, 100% (39/39) of 2% Apple Cider Vinegar the group and 84.6% (33/39) However, these differences are not statistically significant (p-value 0.078). The mean SIRS after two weeks for the Mupirocin group and Apple cider-group showed insignificant differences (p= 0.063). Two-week recovery proportions 5 % Apple cider-group and Mupirocin are statistically indistinguishable from each other (p<0>

Conclusion: In this study, Apple cider vinegar 5 % in cream form proved to be comparable in efficacy with mupirocin 2% cream and generally safe with tolerable side effects in the treatment of localized impetigo and folliculitis in children aged 1-15 years old. However, Mupirocin-treated lesions recover significantly quicker than group of Apple vinegar -treated ones.