What is the typical duration of impetigo with treatment?

Duration of Impetigo with Treatment

Impetigo typically resolves within 7-10 days with appropriate antibiotic treatment, whether using topical or oral antibiotics. 1

Types and Presentation

• Nonbullous impetigo (70% of cases):

  • Caused by Staphylococcus aureus or Streptococcus pyogenes
  • Characterized by honey-colored crusts on erythematous base
  • Typically affects face and extremities

• Bullous impetigo (30% of cases):

  • Caused exclusively by S. aureus
  • Presents with large, flaccid bullae
  • More likely to affect intertriginous areas

Treatment Options and Duration

Topical Antibiotics (First-line for limited disease)

• Recommended agents:
  • Mupirocin 2% ointment
  • Retapamulin
  • Fusidic acid
• Duration: 5-7 days 1
• Expected resolution: Within 7-10 days of starting treatment 2

Oral Antibiotics (For extensive disease or when topical therapy is impractical)

• Recommended agents:
  • First-line: Dicloxacillin or cephalexin (for 7 days) 3
  • For MRSA: Doxycycline, clindamycin, or sulfamethoxazole-trimethoprim 3, 1
  • For penicillin allergy: Clindamycin, erythromycin, or doxycycline (if >8 years old) 1
• Duration: 7-10 days 1
• Expected resolution: Within 7-10 days of starting treatment 2

Monitoring and Follow-up

• If no improvement is seen within 3-5 days of starting treatment, reassess the diagnosis and consider alternative antibiotics 1
• Re-evaluate patients in 24-48 hours if using tetracyclines or trimethoprim-sulfamethoxazole to verify clinical response 1

Natural Course Without Treatment

• Without treatment, impetigo usually resolves spontaneously within 2-3 weeks 2
• However, treatment is recommended to:
  • Relieve discomfort
  • Improve cosmetic appearance
  • Prevent spread of infection
  • Reduce risk of rare complications like poststreptococcal glomerulonephritis

Complications and Prevention

• Complications are rare, with poststreptococcal glomerulonephritis being the most serious (rate <1 case/1,000 population per year) 1
• To prevent spread:
  • Keep lesions covered when possible
  • Use separate towels and linens
  • Practice good hand hygiene
  • Avoid sharing personal items

Key Points to Remember

• Topical antibiotics are as effective as oral antibiotics for limited disease 4, 5
• Treatment significantly shortens the duration of impetigo compared to no treatment
• The choice between topical and oral antibiotics should consider the extent of disease, patient compliance, and local resistance patterns
• Prompt treatment helps prevent spread to others and reduces the duration of symptoms