What is the treatment for impetigo?

Treatment of Impetigo

For impetigo treatment, topical antibiotics (mupirocin 2% ointment or retapamulin 1% ointment) are recommended as first-line therapy for limited lesions, while oral antibiotics are indicated for extensive disease, impractical topical therapy, treatment failure, or systemic symptoms. 1

First-Line Treatment: Topical Antibiotics

• Mupirocin 2% ointment should be applied to affected areas three times daily for 5-7 days for limited impetigo lesions 1, 2
• Retapamulin 1% ointment is an effective alternative, applied twice daily for 5 days 1, 3
• Topical antibiotics have shown better cure rates than placebo (risk ratio 2.24) and are associated with fewer side effects than oral antibiotics 4
• The treated area may be covered with a sterile bandage or gauze dressing if desired 3

Second-Line Treatment: Oral Antibiotics

• Oral antibiotics are recommended for:
  • Extensive disease
  • Cases where topical therapy is impractical
  • Failure of topical treatment
  • Presence of systemic symptoms 1
• Recommended oral antibiotics include:
  • Dicloxacillin
  • First-generation cephalosporins (e.g., cephalexin) 1
• Complete the full course of prescribed antibiotics even if symptoms improve quickly to ensure complete resolution and prevent complications 1

Special Considerations for MRSA

• Consider empiric therapy for community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) in:
  • Patients at risk for CA-MRSA infection
  • Cases with failure to respond to first-line therapy
  • Areas with high local prevalence of CA-MRSA 1
• Treatment options for suspected CA-MRSA include:
  • Trimethoprim-sulfamethoxazole
  • Clindamycin
  • Doxycycline 1, 5

Important Clinical Pearls

• Impetigo is highly contagious and most commonly affects children 2-5 years of age 1, 5
• Causative organisms include Staphylococcus aureus and/or Streptococcus pyogenes 1, 5
• Retapamulin is indicated only for methicillin-susceptible S. aureus, not MRSA 3
• Discontinue topical treatment in the event of sensitization or severe local irritation 3
• Topical disinfectants are inferior to antibiotics and should not be used 5, 6
• Monitor for increasing bacterial resistance, particularly to macrolides and mupirocin 5
• Most cases resolve within 2-3 weeks without scarring when properly treated 5
• Potential complications, though rare, include post-streptococcal glomerulonephritis 1, 5