From the Guidelines
Impetigo should be treated with either topical mupirocin or retapamulin twice daily for 5 days for bullous and nonbullous cases. This recommendation is based on the strongest and most recent evidence available, specifically the 2014 update by the Infectious Diseases Society of America 1.
Key Considerations
- The treatment approach may vary depending on the severity of the infection, with oral therapy recommended for patients with numerous lesions or in outbreaks affecting several people to help decrease transmission of infection.
- For oral therapy, a 7-day regimen with an agent active against S. aureus is recommended, such as dicloxacillin or cephalexin, unless cultures yield streptococci alone, in which case oral penicillin is the recommended agent 1.
- It is essential to practice good hygiene while treating impetigo, including washing the affected areas with soap and water, avoiding touching or scratching the sores, and using separate towels and linens to prevent spread.
Treatment Options
- Topical mupirocin or retapamulin twice daily for 5 days for bullous and nonbullous impetigo
- Oral therapy with dicloxacillin or cephalexin for 7 days for more extensive infections or outbreaks
- Alternative options include amoxicillin-clavulanate or clindamycin for patients with penicillin allergies, and doxycycline, clindamycin, or sulfamethoxazole-trimethoprim (SMX-TMP) when MRSA is suspected or confirmed 1.
From the FDA Drug Label
The efficacy of topical mupirocin ointment in impetigo was tested in two studies. Mupirocin ointment, 2% is indicated for the topical treatment of impetigo due to: Staphylococcus aureus and Streptococcus pyogenes.
The treatment for impetigo is topical mupirocin ointment. Key points about this treatment include:
- Clinical efficacy rates: 71% to 93% in clinical studies 2
- Pathogen eradication rates: 94% to 100% in clinical studies 2
- Indicated pathogens: Staphylococcus aureus and Streptococcus pyogenes 2
From the Research
Treatment Options for Impetigo
- Topical antibiotics such as mupirocin, retapamulin, and fusidic acid are effective treatments for impetigo 3, 4, 5
- 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 3, 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 3
- Treatments under development include minocycline foam and Ozenoxacin, a topical quinolone 3, 6
Considerations for Treatment
- Rising rates of bacterial resistance to standard treatment regimens should inform treatment decisions 3, 7, 6
- Empiric treatment considerations have changed with the increasing prevalence of antibiotic-resistant bacteria, including methicillin-resistant S. aureus, macrolide-resistant streptococcus, and mupirocin-resistant streptococcus 3
- Fusidic acid, mupirocin, and retapamulin cover methicillin-susceptible S. aureus and streptococcal infections, while clindamycin proves helpful in suspected methicillin-resistant S. aureus infections 3
Comparison of Treatment Options
- Topical antibiotic treatment showed better cure rates than placebo, with mupirocin and fusidic acid being equally effective 5
- Topical mupirocin was shown to be slightly superior to oral erythromycin, with no significant differences in cure rates from treatment with topical versus other oral antibiotics 5
- Penicillin was inferior to erythromycin and cloxacillin, with a lack of evidence for the benefit of using disinfectant solutions 5