From the Guidelines
Impetigo should be treated with either topical mupirocin or retapamulin twice daily for 5 days for localized cases, while oral therapy with dicloxacillin or cephalexin for 7 days is recommended for patients with numerous lesions or in outbreaks affecting several people. When considering treatment options, it's essential to weigh the severity of the infection and the potential for transmission. According to the Infectious Diseases Society of America guidelines 1, topical antimicrobials are suitable for bullous and nonbullous impetigo, but oral therapy is preferred in cases with multiple lesions or outbreaks. Key considerations for treatment include:
- Topical mupirocin or retapamulin twice daily for 5 days as first-line therapy for localized cases 1
- Oral dicloxacillin or cephalexin for 7 days for more extensive cases or outbreaks 1
- Alternative oral antibiotics, such as clindamycin or doxycycline, may be used if MRSA is suspected or confirmed 1 It's crucial to note that patients should practice good hygiene, such as gently washing affected areas with soap and water, to prevent the spread of infection. Treatment is vital to prevent complications like cellulitis or post-streptococcal glomerulonephritis, and patients are typically no longer contagious after 24-48 hours of antibiotic treatment.
From the FDA Drug Label
The efficacy of topical mupirocin ointment in impetigo was tested in two studies. CLINICAL STUDIES ... Clinical efficacy rates at end of therapy in the evaluable populations (adults and pediatric patients included) were 71% for mupirocin ointment (n=49) and 35% for vehicle placebo (n=51). In the second study, patients with impetigo were randomized to receive either mupirocin ointment t.i. d. or 30 to 40 mg/kg oral erythromycin ethylsuccinate per day ... Clinical efficacy rates at the follow-up visit in the evaluable populations (adults and pediatric patients included) were 93% for mupirocin ointment (n=29) and 78. 5% for erythromycin (n=28). Mupirocin ointment, 2% is indicated for the topical treatment of impetigo due to: Staphylococcus aureus and Streptococcus pyogenes.
Impetigo Treatment: Mupirocin ointment is indicated for the topical treatment of impetigo due to Staphylococcus aureus and Streptococcus pyogenes 2. The clinical efficacy rates of mupirocin ointment in treating impetigo were 71% and 93% in two studies, compared to 35% for vehicle placebo and 78.5% for oral erythromycin, respectively 2. Mupirocin ointment is effective for the treatment of impetigo, with high clinical efficacy rates and pathogen eradication rates 2.
From the Research
Impetigo Treatment Options
- Impetigo can be treated orally or topically 3
- Topical mupirocin ointment has shown itself to be as effective as oral therapy in many cases and is less likely to be associated with unwanted effects 3
Effectiveness of Topical Antibiotics
- Topical antibiotics are more effective than placebo in treating impetigo (odds ratio = 2.69,95% confidence interval = 1.49 to 4.86) 4
- There is weak evidence for the superiority of topical antibiotics over some oral antibiotics, such as erythromycin (odds ratio = 0.48,95% confidence interval = 0.23 to 1.00) 4
- Topical mupirocin and fusidic acid are equally effective in treating impetigo (odds ratio = 1.76,95% confidence interval = 0.77 to 4.03) 4
Comparison of Topical and Oral Antibiotics
- Topical mupirocin is slightly superior to oral erythromycin in treating impetigo (pooled risk ratio = 1.07,95% confidence interval = 1.01 to 1.13) 5
- There are no significant differences in cure rates from treatment with topical versus other oral antibiotics 5
- Penicillin is inferior to erythromycin and cloxacillin in treating impetigo 5
Specific Treatment Recommendations
- Topical antibiotic treatment for 7 days is recommended for systemically well patients with limited disease 4
- Mupirocin and fusidic acid are effective topical antibiotic treatments for impetigo 5, 6, 7
- Oral erythromycin is an effective treatment for impetigo, but may have more side effects than topical treatments 3, 6