What is the treatment for impetigo?

From the Guidelines

Impetigo is treated with topical or oral antibiotics depending on severity, with topical mupirocin or retapamulin being the first-line treatment for mild, localized cases, and oral antibiotics such as cephalexin, dicloxacillin, or amoxicillin-clavulanate for more extensive cases or when topical therapy fails, as recommended by the Infectious Diseases Society of America 1. The treatment approach for impetigo involves considering the severity of the infection and the potential causative pathogens, which are typically Staphylococcus aureus or Streptococcus pyogenes.

• For mild, localized cases, topical mupirocin (Bactroban) 2% ointment applied twice daily for 5 days or retapamulin 1% ointment applied twice daily for 5 days are recommended as first-line treatments 1.
• For more extensive impetigo (covering multiple body areas) or when topical therapy fails, oral antibiotics are recommended, with options including cephalexin 500 mg four times daily, dicloxacillin 500 mg four times daily, or amoxicillin-clavulanate 875/125 mg twice daily, all for 7 days 1.
• For patients with penicillin allergy, clindamycin 300-450 mg four times daily or doxycycline 100 mg twice daily for 7 days can be used 1. Good hygiene practices are essential during treatment, including:
• Daily washing of the affected areas with soap and water
• Keeping lesions covered
• Using separate towels
• Washing clothes and bedding in hot water Treatment is important to prevent spread to others and complications like cellulitis or glomerulonephritis. Impetigo is typically caused by Staphylococcus aureus or Streptococcus pyogenes, which explains why antibiotics targeting these bacteria are effective 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 treatment for impetigo is topical mupirocin ointment, 2% as indicated by the drug label 2.

• The clinical efficacy rates of mupirocin ointment in treating impetigo were 71% and 93% in two separate studies 2.
• Pathogen eradication rates were 94% and 100% for mupirocin ointment in the two studies 2.

From the Research

Treatment Options for Impetigo

• Topical antibiotics such as mupirocin, retapamulin, and fusidic acid are effective treatments for impetigo 3
• 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
• 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

Specific Treatment Studies

• A study on NVC-422 topical gel for the treatment of impetigo showed high rates of clinical and microbiological responses, with excellent clinical response rates in each of the dose groups (84.6%, 87.2%, and 92.3% in the 0.1%, 0.5% and 1.5% dose groups respectively) 4
• Mupirocin has been shown to be effective in the treatment of impetigo, with an overall 92 percent pathogen eradication rate and a favorable response to treatment in 91 percent of patients 5, 6, 7
• Mupirocin 2% ointment has been shown to be effective in both primary and secondary superficial skin infections, including impetigo, with at least 80% of patients being clinically cured or markedly improved, and over 90% eradication of the bacterial pathogen involved 6

Considerations for Treatment

• The increasing prevalence of antibiotic-resistant bacteria, including methicillin-resistant S. aureus, macrolide-resistant streptococcus, and mupirocin-resistant streptococcus, should be considered when selecting a treatment option 3
• Fusidic acid, mupirocin, and retapamulin cover methicillin-susceptible S. aureus and streptococcal infections, while clindamycin is helpful in suspected methicillin-resistant S. aureus infections 3
• Trimethoprim/sulfamethoxazole covers methicillin-resistant S. aureus infection, but is inadequate for streptococcal infection 3