What is the recommended treatment for a patient with a Staph infection or impetigo?

Treatment of Staph Infections and Impetigo

For staph infections and impetigo, the recommended first-line treatment is incision and drainage for abscesses, with topical mupirocin or retapamulin for impetigo, and oral antibiotics such as trimethoprim-sulfamethoxazole (TMP-SMX) or doxycycline for more extensive staph infections. 1, 2, 3

Impetigo Treatment

Topical Therapy

• First-line treatment for localized impetigo:
  • Retapamulin 1% ointment: Apply thin layer twice daily for 5 days (for patients ≥9 months) 3
  • Mupirocin 2% ointment: Apply three times daily 4
  • Both are effective against Staphylococcus aureus (methicillin-susceptible) and Streptococcus pyogenes

Oral Antibiotics for Impetigo

Indicated when:

• Extensive lesions
• Multiple body sites affected
• Deep tissue involvement
• Systemic symptoms present

Options include:

• Clindamycin (covers both S. aureus and streptococci) 1
• Cephalexin 5
• Amoxicillin/clavulanate 4

Note: Penicillin alone is not recommended due to high rates of resistance 4

Staph Infection Treatment

Uncomplicated Skin and Soft Tissue Infections

Outpatient Management:

• For abscesses: Incision and drainage is the cornerstone of treatment 2

• Empiric antibiotic options for CA-MRSA:

  1. TMP-SMX (1-2 double-strength tablets twice daily) 1, 2
  2. Doxycycline (100 mg twice daily) 1, 2
  3. Clindamycin (300-450 mg three times daily) 1, 2
  4. Linezolid (600 mg twice daily) - reserved for severe cases 1, 2

• When coverage for both MRSA and streptococci is needed:

  • Clindamycin alone 1
  • TMP-SMX or tetracycline plus amoxicillin 1
  • Linezolid alone 1

• Treatment duration: 5-10 days, based on clinical response 1, 2

Complicated Skin and Soft Tissue Infections

Inpatient Management:

• Surgical debridement plus antibiotics

• Parenteral options:

  1. Vancomycin IV (15-20 mg/kg every 8-12 hours) 1, 2
  2. Linezolid 600 mg IV/PO twice daily 1, 2
  3. Daptomycin 4 mg/kg IV once daily 1, 2
  4. Telavancin 10 mg/kg IV once daily 1
  5. Clindamycin 600 mg IV/PO three times daily 1

• Treatment duration: 7-14 days 1, 2

Special Populations

Pediatric Considerations

• For minor skin infections in children: Mupirocin 2% topical ointment 1
• Do not use tetracyclines in children <8 years of age 1
• For hospitalized children with complicated infections:
  • Vancomycin is first-line 1
  • Clindamycin 10-13 mg/kg/dose IV every 6-8 hours if clindamycin resistance is low (<10%) 1
  • Linezolid for children >12 years: 600 mg PO/IV twice daily; for children <12 years: 10 mg/kg/dose PO/IV every 8 hours 1

Prevention of Recurrent Infections

Hygiene Measures

• Keep draining wounds covered with clean, dry bandages
• Regular handwashing with soap and water or alcohol-based hand gel
• Avoid sharing personal items (razors, towels, linens)
• Clean high-touch surfaces regularly 1, 2

Decolonization Strategies

• Consider nasal and topical body decolonization for patients with recurrent infections and their household contacts 1

Common Pitfalls to Avoid

1. Relying solely on antibiotics without drainage for abscesses

   • Incision and drainage remains the primary intervention for abscess management 2

2. Inappropriate antibiotic selection

   • Using penicillin alone for staph infections (high resistance rates) 4
   • Not covering for MRSA when indicated

3. Inadequate treatment duration

   • Too short: may lead to treatment failure
   • Too long: increases risk of antibiotic resistance

4. Not obtaining cultures

   • Cultures are recommended for purulent infections, especially with antibiotic treatment, severe infection, treatment failure, or suspected outbreak 1

5. Overlooking hygiene and prevention measures

   • Essential for preventing recurrent infections 1, 2