What is the recommended treatment for impetigo (a contagious skin infection) on the hand?

Treatment of Impetigo on Hand Lesions

For impetigo on hand lesions, topical mupirocin 2% ointment applied three times daily for 5-7 days is the first-line treatment. 1

First-Line Treatment

• Mupirocin 2% ointment applied to affected areas three times daily for 5-7 days is the recommended initial treatment for localized impetigo on the hands 1
• Mupirocin has shown excellent clinical efficacy rates of 71-93% in clinical trials and is FDA-approved specifically for impetigo caused by Staphylococcus aureus and Streptococcus pyogenes 1
• Clinical studies demonstrate that topical mupirocin is equally effective to oral erythromycin in treating impetigo, with superior eradication of S. aureus 2

When to Consider Oral Antibiotics

• Switch to oral antibiotics if the impetigo is:
  • Extensive (covering multiple sites beyond just the hand) 3
  • Not responding to topical therapy after 3-5 days 3
  • Associated with systemic symptoms 4
  • In areas where topical application is impractical 5

Oral Antibiotic Options

For empirical coverage when oral antibiotics are needed:

• For presumed methicillin-susceptible S. aureus (MSSA):

  • Dicloxacillin: 250 mg four times daily for adults; 12 mg/kg/day in 4 divided doses for children 3
  • Cephalexin: 250-500 mg four times daily for adults; 25 mg/kg/day in 4 divided doses for children 3
  • Amoxicillin-clavulanate: 875/125 mg twice daily for adults; 25 mg/kg/day of amoxicillin component in 2 divided doses for children 3

• If MRSA is suspected or confirmed:

  • Clindamycin: 300-450 mg three times daily for adults; 10-13 mg/kg/dose every 6-8 hours for children 4, 3
  • Trimethoprim-sulfamethoxazole (TMP-SMX): 1-2 double-strength tablets twice daily for adults; 8-12 mg/kg/day in 2 divided doses for children 4
  • Doxycycline: 100 mg twice daily (not for children under 8 years) 4

Important Considerations

• Penicillin alone is not effective for impetigo as it lacks adequate coverage against S. aureus 3
• If both S. aureus and streptococcal coverage is needed, use clindamycin alone or TMP-SMX plus a beta-lactam (e.g., amoxicillin) 4
• TMP-SMX should not be used as a single agent for initial treatment of cellulitis due to possible group A streptococcal resistance 4
• Obtain cultures from lesions if there is treatment failure, MRSA is suspected, or in cases of recurrent infections 4
• Duration of therapy should be 5-7 days for topical treatment and 5-10 days for oral antibiotics 4, 3

Prevention of Spread

• Keep lesions covered with clean, dry bandages 4
• Maintain good personal hygiene with regular handwashing 4
• Avoid sharing personal items that contact the skin 4
• Clean high-touch surfaces that may contact uncovered infections 4
• Consider decolonization strategies for recurrent infections 3

Special Populations

• For children under 8 years: Avoid tetracyclines (doxycycline, minocycline) 4
• For pregnant patients: Cephalexin is generally considered safe; avoid tetracyclines 3
• For extensive disease in children: Clindamycin 10-13 mg/kg/dose IV every 6-8 hours is recommended if hospitalization is required 4