From the Guidelines
Frequent impetigo is typically treated with topical or oral antimicrobials.
Treatment Options
- Topical treatment with mupirocin or retapamulin twice daily for 5 days is effective for bullous and nonbullous impetigo 1.
- Oral therapy with a 7-day regimen of an agent active against S. aureus, such as dicloxacillin or cephalexin, is recommended unless cultures yield streptococci alone, in which case oral penicillin is the recommended agent 1.
- For patients with numerous lesions or in outbreaks affecting several people, oral therapy is preferred to help decrease transmission of infection 1.
- If MRSA is suspected or confirmed, doxycycline, clindamycin, or sulfamethoxazole-trimethoprim (SMX-TMP) is recommended 1.
Key Considerations
- Gram stain and culture of the pus or exudates from skin lesions can help identify the cause of impetigo, but treatment without these studies is reasonable in typical cases 1.
- Clinical experience suggests that systemic therapy is preferred for patients with numerous lesions or in outbreaks affecting several people, to help decrease transmission of infection 1.
From the Research
Treatment Options for Frequent Impetigo
- Topical antibiotics such as mupirocin, retapamulin, and fusidic acid are effective treatments for impetigo 2, 3, 4
- 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, 5, 4
- Natural therapies such as tea tree oil, olive, garlic, and coconut oils, and Manuka honey have been anecdotally successful, but lack sufficient evidence to recommend or dismiss them as treatment options 2
- Treatments under development include minocycline foam and Ozenoxacin, a topical quinolone 2
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 2
- Fusidic acid, mupirocin, and retapamulin cover methicillin-susceptible S. aureus and streptococcal infections, while clindamycin is helpful in suspected methicillin-resistant S. aureus infections 2
- Topical disinfectants are inferior to antibiotics and should not be used 2, 4
Prescribing Patterns
- Oral antibiotics are the most common class of medications used to treat impetigo, but topical antibiotics are equally efficacious and may be a better option to decrease morbidity associated with oral agents 5