From the Guidelines
Amoxicillin is not the recommended first-line treatment for impetigo, as it may not be effective against Staphylococcus aureus, a common cause of the infection. According to the 2014 practice guidelines for the diagnosis and management of skin and soft tissue infections by the Infectious Diseases Society of America 1, oral therapy for impetigo should be a 7-day regimen with an agent active against S. aureus, such as dicloxacillin or cephalexin. Some key points to consider when treating impetigo include:
- Gram stain and culture of the pus or exudates from skin lesions can help identify the cause of the infection, but treatment without these studies is reasonable in typical cases 1
- Topical antimicrobials, such as mupirocin or retapamulin, can be used to treat bullous and nonbullous impetigo, but oral therapy is recommended for patients with numerous lesions or in outbreaks affecting several people 1
- Oral penicillin is only recommended when cultures yield streptococci alone 1 It's essential to note that amoxicillin may not be effective against S. aureus, and alternative antibiotics like clindamycin or sulfamethoxazole-trimethoprim may be more appropriate if MRSA is suspected or confirmed 1. Patients should practice good hygiene and complete the full course of antibiotics to ensure effective treatment and prevent the spread of infection.
From the Research
Amoxicillin for Impetigo
- Amoxicillin is not typically used as a first-line treatment for impetigo, as it is not effective against methicillin-resistant Staphylococcus aureus (MRSA) 2.
- However, amoxicillin/clavulanate is listed as an option for oral antibiotic therapy in the treatment of impetigo, particularly for cases with large bullae or when topical therapy is impractical 2.
- There is no direct comparison of amoxicillin to other antibiotics in the treatment of impetigo in the provided studies.
Alternative Treatments for Impetigo
- Topical antibiotics such as mupirocin, retapamulin, and fusidic acid are commonly used to treat impetigo 2, 3, 4.
- Oral antibiotics such as cephalexin, clindamycin, and doxycycline may also be used, but penicillin is not recommended due to its lack of effectiveness against MRSA 2.
- Natural therapies such as tea tree oil and Manuka honey have been anecdotally successful, but lack sufficient evidence to recommend or dismiss them as treatment options 2.
Resistance Patterns and Treatment Algorithms
- Antimicrobial resistance patterns are an important consideration in the treatment of impetigo, and treatment algorithms have been developed to address this issue 5.
- The choice of antibiotic should take into account local resistance patterns and the severity of the infection 5.
- Ozenoxacin cream 1% is a highly effective option against S. pyogenes and S. aureus, including MRSA, and may be a suitable option for localized impetigo 5.