What is the recommended antibiotic regimen for impetigo (a highly contagious bacterial skin infection) on the face?

From the Guidelines

For impetigo on the face, the recommended first-line treatment is topical mupirocin or retapamulin ointment applied twice daily for 5 days, as stated in the 2014 update by the Infectious Diseases Society of America 1. This approach is based on the strong, high-quality evidence that supports the use of topical antimicrobials for the treatment of bullous and nonbullous impetigo. The use of topical mupirocin or retapamulin is recommended for patients with a limited number of lesions, as seen in the guidelines 1. Some key points to consider when treating impetigo on the face include:

• The causative organisms are typically Staphylococcus aureus and Streptococcus pyogenes, which these antibiotics effectively target 1.
• Patients should gently wash the affected areas with soap and water 2-3 times daily, avoid touching or scratching the lesions, use separate towels and linens, and complete the full course of antibiotics even if symptoms improve quickly.
• If no improvement occurs within 3-4 days or if symptoms worsen, medical reevaluation is necessary.
• For more extensive facial impetigo, oral antibiotics may be necessary, with options including cephalexin or dicloxacillin for 7 days, as recommended in the guidelines 1. It's essential to note that the treatment of impetigo should be guided by the severity of the infection, the number of lesions, and the patient's overall health status, as well as the potential for antibiotic resistance and the need for proper antibiotic stewardship 1.

From the FDA Drug Label

CLINICAL STUDIES The efficacy of topical mupirocin ointment in impetigo was tested in two studies. INDICATIONS AND USAGE Mupirocin ointment, 2% is indicated for the topical treatment of impetigo due to: Staphylococcus aureus and Streptococcus pyogenes.

The recommended antibiotic regimen for impetigo on the face is topical mupirocin ointment, as it has shown clinical efficacy rates of 71% to 96% in treating impetigo caused by Staphylococcus aureus and Streptococcus pyogenes 2.

• Treatment duration: 8 to 12 days
• Application frequency: three times a day (t.i.d.)
• Pediatric use: safe and effective in pediatric patients aged 2 months to 15 years 2.

From the Research

Impetigo Antibiotic Regimen on Face

• Impetigo is a common bacterial skin infection that can be treated with topical or oral antibiotics 3.
• The choice of antibiotic regimen depends on the severity of the infection, the presence of antibiotic-resistant bacteria, and the patient's preferences 4.
• Topical antibiotics such as mupirocin, fusidic acid, and retapamulin are effective in treating impetigo, especially for mild to moderate cases 5, 6.
• Oral antibiotics such as amoxicillin/clavulanate, dicloxacillin, cephalexin, and clindamycin may be used for more severe cases or when topical therapy is impractical 3, 7.
• Mupirocin and fusidic acid have been shown to be equally effective in treating impetigo, and are superior to oral erythromycin in some cases 5, 6.
• Penicillin is not recommended as a first-line treatment for impetigo due to its lower efficacy compared to other antibiotics 7, 6.
• The use of disinfectant solutions is not supported by evidence and is not recommended as a treatment for impetigo 6.
• It is essential to consider the growing resistance rates of bacteria causing impetigo to commonly used antibiotics when selecting a treatment regimen 3, 6.