From the Guidelines
Doxycycline is a recommended treatment for impetigo, particularly in cases where methicillin-resistant Staphylococcus aureus (MRSA) is suspected or confirmed, as stated in the 2014 guidelines by the Infectious Diseases Society of America 1. When considering treatment options for impetigo, it's essential to note that first-line treatments typically include topical mupirocin ointment for limited infections or oral antibiotics like cephalexin or dicloxacillin for more widespread cases. However, doxycycline can be an effective alternative, especially in cases where MRSA is suspected, as it is active against this bacterium. The typical adult dosage of doxycycline for impetigo is 100 mg twice daily for 7-10 days, as recommended in the guidelines 1. For children over 8 years old, the dose is typically 2-4 mg/kg/day divided into two doses, not exceeding adult dosage. It's crucial to consider the potential side effects and contraindications of doxycycline, such as permanent tooth discoloration and effects on bone development in children under 8 years old, pregnant women, or nursing mothers. Additionally, when taking doxycycline, it's essential to take it with plenty of water, avoid dairy products or antacids within 2 hours of taking it, and stay upright for 30 minutes after taking it to prevent esophageal irritation. Sun protection is also vital as doxycycline can increase sensitivity to sunlight. The 2018 consensus conference by the World Journal of Emergency Surgery also supports the use of antibiotics against Gram-positive bacteria, including doxycycline, for the treatment of impetigo, especially in cases where MRSA is suspected 1. Key points to consider when treating impetigo with doxycycline include:
- Dosage: 100 mg twice daily for 7-10 days in adults, and 2-4 mg/kg/day divided into two doses in children over 8 years old
- Contraindications: children under 8 years old, pregnant women, or nursing mothers
- Potential side effects: permanent tooth discoloration, effects on bone development, esophageal irritation, and increased sensitivity to sunlight
- Importance of sun protection and proper administration of the medication to minimize side effects.
From the Research
Effectiveness of Doxy for Impetigo
- Doxy, also known as doxycycline, is an oral antibiotic that can be used to treat impetigo, especially in cases with large bullae or when topical therapy is impractical 2.
- According to a study published in the American Family Physician, doxycycline is one of the options for oral antibiotic therapy for impetigo, along with other antibiotics such as amoxicillin/clavulanate, dicloxacillin, and cephalexin 2.
- However, another study published in the same journal notes that there is no clear preference among antistaphylococcal penicillins, amoxicillin/clavulanate, cephalosporins, and macrolides, including doxycycline, for the treatment of impetigo 3.
Comparison with Other Treatments
- A systematic review of interventions for impetigo found that topical antibiotic treatment showed better cure rates than placebo, but there was no clear evidence that oral antibiotics, including doxycycline, were more effective than topical antibiotics 4.
- The review also found that penicillin was inferior to erythromycin, and that cloxacillin was more effective than penicillin, but there was no comparison with doxycycline 4.
- Another study published in the Journal of Clinical Pharmacy and Therapeutics notes that the increasing prevalence of antibiotic-resistant bacteria makes the successful management of impetigo a concern, and that new topical antimicrobials and antiseptics may be needed as an alternative treatment strategy 5.
Conclusion on Doxy's Effectiveness
- While doxycycline can be used to treat impetigo, the evidence suggests that it is not necessarily more effective than other antibiotics or topical treatments 2, 3, 4.
- The choice of treatment for impetigo should be based on the severity of the infection, the presence of antibiotic-resistant bacteria, and the patient's individual needs and circumstances 2, 5.