What is the treatment for lip infection?

Treatment for Lip Infection

The treatment for lip infection includes applying white soft paraffin ointment to the lips every 2 hours, using antiseptic oral rinses containing chlorhexidine twice daily, and administering appropriate antibiotics for bacterial infections, particularly for Staphylococcus aureus which is a common causative organism. 1, 2

Initial Assessment and Diagnosis

• Examine the lips thoroughly to determine the type and extent of infection, as treatment approach varies based on whether it's bacterial, fungal, or viral 1
• For bacterial lip infections, Staphylococcus aureus is the most common causative organism, which may present as an abscess requiring prompt treatment 2
• Consider immunocompromised status of the patient, as this affects treatment approach and prognosis 2
• Take cultures from the infected area before starting antibiotics to guide targeted therapy 2

Topical Treatment Approach

For All Lip Infections:

• Apply white soft paraffin ointment to the lips every 2 hours throughout the acute illness 1
• Clean the mouth daily with warm saline mouthwashes or an oral sponge to reduce bacterial load 1
• Use an antiseptic oral rinse containing chlorhexidine twice daily (0.2% chlorhexidine digluconate mouthwash) 1
  • Consider diluting chlorhexidine by up to 50% to reduce associated soreness 1
• For painful infections, use an anti-inflammatory oral rinse containing benzydamine hydrochloride every 3 hours, particularly before eating 1

For Bacterial Infections:

• For minor superficial bacterial infections, topical mupirocin ointment or cream applied three times daily is effective against Staphylococcus aureus and Streptococcus pyogenes 3
• Mupirocin cream has shown similar or superior efficacy compared to oral antibiotics in experimental skin infections 3
• Avoid prolonged use of mupirocin as it may lead to overgrowth of nonsusceptible organisms 4

Systemic Treatment

• For more severe or deep bacterial lip infections, particularly abscesses:
  • Intravenous antibiotics effective against Staphylococcus aureus are required, followed by oral antibiotics 2
  • Consider methicillin-resistant Staphylococcus aureus (MRSA) coverage if risk factors are present or if necrotic/cavitated lesions are observed 5, 2
• Surgical drainage is necessary for lip abscesses, especially those larger than 10mm 2, 6
• The average inpatient stay for severe lip infections requiring IV antibiotics is approximately 4 days 2

Special Considerations

• For suspected fungal infections (e.g., candidiasis), use nystatin oral suspension 100,000 units four times daily for 1 week, or miconazole oral gel 5-10 mL held in the mouth after food four times daily for 1 week 1
• For persistent infections, consider topical corticosteroids to reduce inflammation:
  • Betamethasone sodium phosphate 0.5 mg in 10 mL water as a 3-minute rinse-and-spit preparation four times daily 1
  • For localized lesions, clobetasol propionate 0.05% mixed in equal amounts with Orabase can be applied directly to affected areas daily 1
• For human bite injuries to the lips:
  • If less than 10mm, treat conservatively with antibiotics
  • If greater than 10mm, surgical treatment is indicated
  • If infection is present, delay surgery until infection resolves 6

Common Pitfalls and Caveats

• Avoid chronic use of paraffin (petrolatum) on lips as it promotes mucosal cell dehydration and is occlusive, leading to risk of secondary infection 1
• Don't mistake fixed drug eruptions on the lips for herpes simplex infections; consider medication history, especially antifungals like fluconazole 7
• For immunocompromised patients, be more aggressive with treatment and consider broader antimicrobial coverage 2
• Regular follow-up is essential to ensure complete resolution of the infection and to prevent complications such as scarring 1