Topical retapamulin (Altabax, Altargo) is the first pleuromutilin antibacterial 
approved for the treatment of uncomplicated superficial skin infections caused 
by Staphylococcus aureus (excluding meticillin-resistant S. aureus [MRSA]) and 
Streptococcus pyogenes in patients aged > or = 9 months. In the EU, retapamulin 
is indicated for use in patients with impetigo or with infected small 
lacerations, abrasions or sutured wounds (without abscesses); in the US, it is 
indicated for use in patients with impetigo. Retapamulin has a novel site of 
action on bacterial ribosomes. In clinical trials in patients with impetigo, 
topical retapamulin 1% ointment twice daily for 5 days (the approved regimen) 
was superior to placebo; treatment with retapamulin was noninferior to that with 
topical fusidic acid. In patients with secondarily infected traumatic lesions, 
treatment with retapamulin was noninferior to that with oral cefalexin, although 
the efficacy of retapamulin was reduced in patients with MRSA infections or 
superficial abscesses. Retapamulin was well tolerated in both paediatric and 
adult patients, and the majority of adverse events were of mild to moderate 
severity. Thus, the introduction of topical retapamulin 1% ointment extends the 
treatment options available in the management of impetigo and uncomplicated 
secondarily infected traumatic lesions.