From the Guidelines
The treatment for pediatric bullous impetigo should be with either topical mupirocin or retapamulin twice daily for 5 days. This recommendation is based on the strongest and most recent evidence available, which suggests that topical antimicrobials are effective for treating bullous and nonbullous impetigo 1.
Key Considerations
- The choice between topical and oral antimicrobials depends on the severity of the infection and the number of lesions.
- Oral therapy is recommended for patients with numerous lesions or in outbreaks affecting several people to help decrease transmission of infection 1.
- 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.
Treatment Options
- Topical mupirocin or retapamulin twice daily for 5 days for localized cases.
- Oral antibiotics, such as cephalexin or dicloxacillin, for more extensive disease or outbreaks.
Supportive Care
- Gentle cleansing of affected areas with warm water and mild soap.
- Avoiding scrubbing, which can spread the infection.
- Keeping the child's fingernails short to prevent scratching and spreading the bacteria.
- Using separate towels and linens.
- Encouraging frequent handwashing to prevent the spread of infection.
From the FDA Drug Label
Mupirocin ointment, 2% is indicated for the topical treatment of impetigo due to: Staphylococcus aureus and Streptococcus pyogenes. The treatment for pediatric bullous impetigo is topical mupirocin ointment, 2%.
- The safety and effectiveness of mupirocin ointment have been established in the age range of 2 months to 16 years 2, 2.
- It is for external use only and should be used as directed by a healthcare practitioner.
- If irritation, severe itching, or rash occurs, the medication should be stopped and a healthcare practitioner contacted.
From the Research
Treatment Options for Pediatric Bullous Impetigo
- Topical antibiotics such as mupirocin, retapamulin, and fusidic acid are effective in treating bullous impetigo 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 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
Considerations for Treatment
- The increasing prevalence of antibiotic-resistant bacteria, including methicillin-resistant S. aureus, macrolide-resistant streptococcus, and mupirocin-resistant streptococcus, should inform treatment decisions 3, 5
- Fusidic acid, mupirocin, and retapamulin cover methicillin-susceptible S. aureus and streptococcal infections 3
- Clindamycin proves helpful in suspected methicillin-resistant S. aureus infections, but resistance rates are increasing 3, 5
- Cephalosporins may be recommended to treat uncomplicated cases of bullous impetigo due to high rates of clindamycin resistance 5
Diagnosis and Misdiagnosis
- Bullous impetigo can be misdiagnosed, especially in children with atopic dermatitis, and increased training is likely needed for pediatricians, emergency room physicians, and dermatologists 5
- Earlier diagnosis of bullous impetigo may prevent dissemination and spare a patient treatment with systemic antibiotics 5