From the Guidelines
The recommended treatment for impetigo is topical mupirocin or retapamulin twice daily for 5 days for limited disease, and oral antibiotics such as cephalexin or dicloxacillin for 7 days for more extensive cases. According to the 2014 update by the Infectious Diseases Society of America 1, treatment of bullous and nonbullous impetigo should be with either topical mupirocin or retapamulin twice daily for 5 days.
- Key considerations for treatment include:
- The severity and extent of the disease
- The presence of methicillin-resistant Staphylococcus aureus (MRSA)
- The need for oral therapy in cases of numerous lesions or outbreaks
- Oral therapy for ecthyma or impetigo should be a 7-day regimen 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.
- In areas with high MRSA prevalence, alternative antibiotics such as doxycycline, clindamycin, or sulfamethoxazole-trimethoprim may be preferred 1.
- Good hygiene practices, including regular handwashing, avoiding sharing personal items, and washing clothing and bedding in hot water, are essential to prevent the spread of impetigo 1.
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 recommended treatment for impetigo is topical mupirocin ointment, 2% 2, which is indicated for the treatment of impetigo due to Staphylococcus aureus and Streptococcus pyogenes 2.
- Clinical efficacy rates for mupirocin ointment were 71% in one study and 93% in another study 2.
- Pathogen eradication rates were 94% and 100% for mupirocin ointment in the two studies 2.
From the Research
Impetigo Treatment Overview
- Impetigo is a highly contagious, superficial skin infection that can be treated with various options, including topical and oral antibiotics 3, 4.
- The two types of impetigo are nonbullous impetigo (i.e., impetigo contagiosa) and bullous impetigo, with nonbullous being the most common type 3.
Topical Antibiotics
- Topical antibiotics such as mupirocin, retapamulin, and fusidic acid are effective in treating impetigo, especially for mild cases 3, 4, 5.
- Mupirocin and fusidic acid have been shown to be equally effective, or more effective than oral treatment for people with limited disease 5.
- Topical antibiotics are less likely to be associated with unwanted effects compared to oral antibiotics 6.
Oral Antibiotics
- Oral antibiotics such as amoxicillin/clavulanate, dicloxacillin, cephalexin, clindamycin, doxycycline, minocycline, trimethoprim/sulfamethoxazole, and macrolides can be used to treat impetigo, especially for extensive disease or when topical therapy is impractical 3, 4.
- Penicillin is not recommended as a treatment option due to its low efficacy compared to other antibiotics 4, 5.
Natural Therapies and Disinfectants
- 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.
- Topical disinfectants are not useful in the treatment of impetigo and are inferior to antibiotics 3, 4, 5.
Treatment Considerations
- The increasing prevalence of antibiotic-resistant bacteria should be taken into account when choosing a treatment option 3.
- Clindamycin can be helpful in suspected methicillin-resistant S. aureus infections, while trimethoprim/sulfamethoxazole can cover methicillin-resistant S. aureus infection, but is inadequate for streptococcal infection 3.