From the Guidelines
For recurrent impetigo, the best treatment is typically oral antibiotics that target methicillin-resistant Staphylococcus aureus (MRSA), with doxycycline, clindamycin, or sulfamethoxazole-trimethoprim (SMX-TMP) being recommended options 1. When treating recurrent impetigo, it is essential to consider the possibility of MRSA infection, as it has become increasingly common in community-acquired skin infections.
- The recommended oral antibiotics for MRSA include:
- Doxycycline (100 mg twice daily for adults; not recommended for children under 8)
- Clindamycin (300-450 mg orally four times daily for adults; 10-20 mg/kg/day divided three times daily for children)
- Sulfamethoxazole-trimethoprim (SMX-TMP, 1-2 double-strength tablets twice daily for adults or 8-12 mg/kg/day of the trimethoprim component divided twice daily for children) for 7-10 days
- Topical mupirocin 2% ointment applied three times daily for 5-7 days can be used as adjunctive therapy, but it is not recommended as a sole treatment for recurrent impetigo due to the high risk of resistance development 1.
- Good wound care is essential, including gently removing crusts with warm compresses and washing the area with antibacterial soap twice daily.
- Patients should complete the full course of antibiotics even if symptoms improve quickly to prevent recurrence and further resistance development. It is crucial to note that the treatment of recurrent impetigo should be guided by the results of Gram stain and culture of the pus or exudates from skin lesions, if available, to ensure the most effective treatment is chosen 1.
From the Research
Treatment Options for Recurrent Impetigo
The treatment of recurrent impetigo, which is resistant to treatment, can be challenging. Several studies have investigated the effectiveness of different treatment options, including oral and topical antibiotics.
- Oral antibiotics, such as erythromycin 2, cephalexin 3, and dicloxacillin 3, have been shown to be effective in treating impetigo.
- Topical antibiotics, such as mupirocin 2, 4, 5 and fusidic acid 5, have also been found to be effective, with some studies suggesting that they may be as effective as, or even more effective than, oral antibiotics 5.
- Retapamulin, a newly developed topical treatment, has also been shown to be effective, with no reported resistance yet 5.
Considerations for Treatment-Resistant Cases
In cases where impetigo is resistant to treatment, it may be necessary to consider alternative treatment options.
- Oral cephalexin or dicloxacillin may be considered for treatment-resistant cases 4.
- Methicillin-resistant Staphylococcus aureus (MRSA) coverage should be considered for patients with infections that have not improved with treatment 4.
- Culture of the exudate is recommended in recurrent cases to guide treatment 4.
Comparison of Treatment Options
Several studies have compared the effectiveness of different treatment options for impetigo.