From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Yes, bullous impetigo sometimes requires inpatient treatment, particularly in severe cases or when complications develop. Hospitalization is typically necessary for patients with extensive disease, systemic symptoms (fever, malaise), immunocompromised status, or when the infection fails to respond to oral antibiotics. According to the most recent and highest quality study available, which is the 2012 Cochrane review 1, topical antibiotic treatment showed better cure rates than placebo, and topical mupirocin was shown to be slightly superior to oral erythromycin. However, in severe cases, inpatient management usually involves intravenous antibiotics such as nafcillin, oxacillin, or cefazolin for methicillin-sensitive Staphylococcus aureus, or vancomycin, daptomycin, or linezolid for methicillin-resistant strains.
Some key points to consider when deciding on inpatient treatment for bullous impetigo include:
- Extent of the disease: Patients with extensive disease may require inpatient treatment to ensure close monitoring and management of potential complications.
- Systemic symptoms: Patients with systemic symptoms such as fever, malaise, or immunocompromised status may require inpatient treatment to manage these symptoms and prevent further complications.
- Response to oral antibiotics: Patients who do not respond to oral antibiotics may require inpatient treatment with intravenous antibiotics.
- Risk of complications: Patients at risk of developing complications such as cellulitis, bacteremia, or sepsis may require inpatient treatment to manage these complications.
The 2014 American Family Physician study 2 also notes that bullous impetigo is caused by Staphylococcus aureus strains that produce exfoliative toxins, creating fragile, fluid-filled blisters that can rapidly spread and cause significant discomfort and risk of secondary infection if not properly managed. The 2004 Expert Review of Anti-Infective Therapy study 3 provides additional guidance on the treatment of bullous impetigo, including the use of topical antibiotics such as fusidic acid and mupirocin.
Overall, while outpatient treatment may be sufficient for mild cases of bullous impetigo, inpatient treatment is sometimes necessary to manage severe cases or prevent complications. Treatment duration is typically 7-10 days, with transition to oral antibiotics once clinical improvement occurs. Supportive care includes pain management, wound care with gentle cleansing and topical antibiotics, and maintaining adequate hydration and nutrition. Hospitalization allows for close monitoring of disease progression, prevention of spread to others, and management of complications like cellulitis, bacteremia, or sepsis.