From the Guidelines
Impetigo treatment should involve topical antimicrobials, such as mupirocin or retapamulin, applied twice daily for 5 days, as this approach is effective for localized, mild cases 1. When considering treatment options, it's essential to weigh the severity of the impetigo and the potential for transmission.
- For localized, mild cases, topical treatment is sufficient, with mupirocin or retapamulin being the preferred options 1.
- For more extensive impetigo or cases involving numerous lesions, oral antibiotics are recommended to help decrease transmission of infection 1. Some key points to consider when treating impetigo include:
- The use of oral penicillinase–resistant penicillin or first-generation cephalosporins, such as cephalexin or dicloxacillin, for 7 days, as these are usually effective against methicillin-susceptible staphylococcal isolates 1.
- The consideration of alternative antibiotics, such as clindamycin, doxycycline, or trimethoprim-sulfamethoxazole, in cases where MRSA is suspected or confirmed, or in patients with penicillin allergies 1.
- The importance of gently washing the affected areas with soap and water to remove crusts before applying medication, and avoiding sharing towels or close contact until 24-48 hours after starting antibiotics to prevent spread and complications 1.
From the FDA Drug Label
ALTABAX, a pleuromutilin antibacterial, is indicated for the topical treatment of impetigo due to Staphylococcus aureus (methicillin-susceptible isolates only) or Streptococcus pyogenes in patients aged 9 months or older. Mupirocin ointment, 2% is indicated for the topical treatment of impetigo due to: Staphylococcus aureus and Streptococcus pyogenes.
Impetigo Treatment Options:
- Retapamulin (ALTABAX) ointment, 1%: Apply a thin layer to the affected area twice daily for 5 days 2.
- Mupirocin ointment, 2%: for the topical treatment of impetigo due to Staphylococcus aureus and Streptococcus pyogenes 3.
Key Considerations:
- Retapamulin is indicated for patients aged 9 months or older 2.
- Safety in patients younger than 9 months has not been established for retapamulin 2.
From the Research
Impetigo Treatment Options
- Topical antibiotics such as mupirocin, retapamulin, and fusidic acid are effective treatments for impetigo 4, 5, 6
- 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 4, 7, 8
- Penicillin is not a recommended treatment option due to its inferior efficacy compared to other antibiotics 7, 5, 8
Comparison of Treatment Options
- Topical mupirocin and fusidic acid have similar efficacy and are more effective than oral erythromycin 5
- Retapamulin and ozenoxacin are effective alternatives to mupirocin, but may be more expensive 6
- Cephalexin is a effective treatment option, with a lower treatment failure rate compared to penicillin and erythromycin 8
Considerations for Treatment
- The increasing prevalence of antibiotic-resistant bacteria, including methicillin-resistant S. aureus, macrolide-resistant streptococcus, and mupirocin-resistant streptococcus, should be considered when selecting a treatment option 4
- The cost and insurance coverage of different treatment options should also be taken into account 6