From the Guidelines
Systemic impetigo should be treated with oral antibiotics, specifically a 7-day regimen with an agent active against Staphylococcus aureus, such as dicloxacillin or cephalexin, unless cultures yield streptococci alone, in which case oral penicillin is recommended 1. The treatment of systemic impetigo is crucial to prevent further complications and reduce the risk of transmission.
Key Considerations
- The choice of antibiotic should be based on the suspected causative bacteria, with dicloxacillin or cephalexin being the first-line treatment options for methicillin-susceptible S. aureus 1.
- For patients with penicillin allergies, clindamycin or trimethoprim-sulfamethoxazole may be used as alternative treatment options 1.
- If MRSA is suspected or confirmed, doxycycline, clindamycin, or sulfamethoxazole-trimethoprim (SMX-TMP) are recommended as treatment options 1.
Treatment Approach
- Oral antibiotics should be administered for a duration of 7 days, unless otherwise specified by culture results or clinical judgment 1.
- Patients should be advised to keep the affected areas clean by gently washing with mild soap and water twice daily, and cover open sores with non-stick bandages to prevent spread.
- It is essential to complete the full course of antibiotics, even if symptoms improve quickly, to ensure effective treatment and prevent the development of antibiotic-resistant bacterial strains.
- If symptoms worsen or do not improve within 48-72 hours of starting antibiotics, medical attention should be sought as the bacterial strain may be resistant to the prescribed medication.
From the FDA Drug Label
INDICATIONS AND USAGE Mupirocin ointment, 2% is indicated for the topical treatment of impetigo due to: Staphylococcus aureus and Streptococcus pyogenes. The FDA drug label does not answer the question.
From the Research
Treatment Options for Systemic Impetigo
- Topical antibiotics such as mupirocin, retapamulin, and fusidic acid are effective for treating impetigo 2
- Oral antibiotic therapy can be used for impetigo with large bullae or when topical therapy is impractical, with options including amoxicillin/clavulanate, dicloxacillin, cephalexin, clindamycin, doxycycline, minocycline, trimethoprim/sulfamethoxazole, and macrolides 2, 3
- For systemic impetigo, an antistaphylococcal oral antibiotic is the preferred treatment, and a therapeutic agent that is effective against both S aureus and streptococci is appropriate for most cases 3
- Treatment for limited impetigo is topical, whereas oral therapy is recommended for extensive cases 4
- Rising rates of bacterial resistance to standard treatment regimens should inform treatment decisions, and it is essential to know the local trends in antibiotic resistance when prescribing antibiotics 5
Considerations for Antibiotic Resistance
- Resistance to oral and topical antibiotics prescribed for the treatment of impetigo, such as mupirocin, retapamulin, and fusidic acid, have been widely reported 5
- Ozenoxacin cream 1% is highly effective against S. pyogenes and S. aureus, including methycyllin-susceptible and resistant strains (MRSA), and may be a suitable option for localized impetigo 5
- Clindamycin proves helpful in suspected methicillin-resistant S. aureus infections, and trimethoprim/sulfamethoxazole covers methicillin-resistant S. aureus infection, but is inadequate for streptococcal infection 2
Additional Treatment Measures
- Education and prevention of impetigo, diagnosis and classification, treatment measures, and follow-up are important aspects of managing impetigo 5
- An evidence-based impetigo treatment algorithm can be used to address the treatment of impetigo for pediatric and adult populations, taking into account antimicrobial stewardship and the increasing resistance to oral and topical antibiotics 5