From the Guidelines
Impetigo should be treated with either topical mupirocin or retapamulin twice daily for 5 days for bullous and nonbullous cases, as this approach has been shown to be effective in managing the infection. The treatment of impetigo depends on the severity and extent of the infection. According to the practice guidelines for the diagnosis and management of skin and soft tissue infections updated by the Infectious Diseases Society of America in 2014 1, topical antimicrobials are recommended for mild cases, while oral therapy is suggested for patients with numerous lesions or in outbreaks affecting several people to help decrease transmission of infection.
Key Considerations for Treatment
- For topical treatment, mupirocin or retapamulin applied twice daily for 5 days is recommended 1 due to their efficacy against Staphylococcus aureus and β-hemolytic Streptococcus, the common causes of impetigo.
- Oral therapy is recommended for more extensive cases or outbreaks, with a 7-day regimen of an agent active against S. aureus, such as dicloxacillin or cephalexin, unless cultures indicate Streptococcus pyogenes alone, in which case oral penicillin is preferred 1.
- In cases where methicillin-resistant S. aureus (MRSA) is suspected or confirmed, doxycycline, clindamycin, or sulfamethoxazole-trimethoprim (SMX-TMP) is recommended 1.
Additional Management Strategies
- Gentle cleansing of the affected areas with warm water and mild soap can help remove crusts and promote healing.
- Keeping the affected areas covered can prevent the spread of the infection to others.
- Patients should avoid touching or scratching the sores to prevent spreading the infection to other body parts or to other people, as impetigo is highly contagious.
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
The treatment for impetigo includes:
- Topical antibiotics such as mupirocin, retapamulin, and fusidic acid 3, 4, 5
- Oral antibiotic therapy for impetigo with large bullae or when topical therapy is impractical 3, 5, 6
- 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
Antibiotic Therapy
- Amoxicillin/clavulanate, dicloxacillin, cephalexin, clindamycin, doxycycline, minocycline, trimethoprim/sulfamethoxazole, and macrolides are options for oral antibiotic therapy 3
- Penicillin is not a recommended option due to its inferiority to other antibiotics 3, 4, 6
- Fusidic acid, mupirocin, and retapamulin cover methicillin-susceptible S. aureus and streptococcal infections 3
- Clindamycin is helpful in suspected methicillin-resistant S. aureus infections 3
- Trimethoprim/sulfamethoxazole covers methicillin-resistant S. aureus infection, but is inadequate for streptococcal infection 3