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 as the first-line treatment for bullous and nonbullous impetigo.
- Oral therapy is recommended for more extensive infections or when there are numerous lesions, with a suggested regimen of 7 days with an agent active against S. aureus, such as dicloxacillin or cephalexin, unless cultures yield streptococci alone, in which case oral penicillin is recommended 1.
- When MRSA is suspected or confirmed, alternative antibiotics such as doxycycline, clindamycin, or sulfamethoxazole-trimethoprim (SMX-TMP) should be considered 1.
Additional Management Strategies
- Gentle cleansing of affected areas with warm water and mild soap, removing crusts, and keeping the area clean can help speed healing.
- Patients should avoid scratching to prevent spreading the infection and should use separate towels and washcloths.
- Impetigo is highly contagious and caused by Staphylococcus aureus or Streptococcus pyogenes bacteria that infect the superficial skin layers, making prompt and effective treatment crucial to prevent complications like cellulitis or, rarely, post-streptococcal glomerulonephritis.
From the FDA Drug Label
Mupirocin ointment, 2% is indicated for the topical treatment of impetigo due to: Staphylococcus aureus and Streptococcus pyogenes. The efficacy of topical mupirocin ointment in impetigo was tested in two studies. In the first, patients with impetigo were randomized to receive either mupirocin ointment or vehicle placebo t.i. d. for 8 to 12 days. Clinical efficacy rates at end of therapy in the evaluable populations (adults and pediatric patients included) were 71% for mupirocin ointment (n=49) and 35% for vehicle placebo (n=51).
The treatment for impetigo is topical mupirocin ointment, which has been shown to be effective in clinical studies 2. The causes of impetigo that can be treated with mupirocin ointment are:
- Staphylococcus aureus
- Streptococcus pyogenes 2.
From the Research
Impetigo Cause and Treatment
Impetigo is a highly contagious, superficial skin infection that most commonly affects children two to five years of age. The two types of impetigo are nonbullous impetigo (i.e., impetigo contagiosa) and bullous impetigo.
Causes of Impetigo
- Nonbullous impetigo, or impetigo contagiosa, is caused by Staphylococcus aureus or Streptococcus pyogenes 3
- Bullous impetigo, which is caused exclusively by S. aureus 3
Treatment Options for Impetigo
- Topical antibiotics such as mupirocin, retapamulin, and fusidic acid are effective treatments for impetigo 3, 4, 5, 6, 7
- Oral antibiotic therapy can be used for impetigo with large bullae or when topical therapy is impractical 3, 7
- Amoxicillin/clavulanate, dicloxacillin, cephalexin, clindamycin, doxycycline, minocycline, trimethoprim/sulfamethoxazole, and macrolides are options for oral antibiotic therapy 3
- Penicillin is not a recommended treatment option due to its low efficacy 5, 6, 7
- Topical disinfectants are not useful in the treatment of impetigo 3, 6, 7