Restrictions for Athletes with Impetigo in Contact Sports
Athletes with impetigo must complete 72 hours of antibiotic therapy, have no moist or draining lesions, and have no new lesions for 48 hours before returning to contact sports. 1
Return-to-Play Criteria for Impetigo
Impetigo is a highly contagious bacterial skin infection commonly caused by Staphylococcus aureus or Group A Streptococcus (GABHS). Athletes participating in contact sports must adhere to the following restrictions before returning to competition:
- Complete at least 72 hours of appropriate antibiotic therapy 1
- Have no new skin lesions for at least 48 hours before competition 1
- Have no moist, weeping, exudative, or draining lesions at the time of practice or competition 1
- All lesions should have well-adhering scabs 1
- Active purulent lesions cannot be covered to allow participation 1
- Only dry, scabbed lesions may be covered with bio-occlusive dressings 1
Guidelines by Sports Organizations
Different athletic organizations have established specific criteria for return to play:
NCAA (National Collegiate Athletic Association) Requirements:
- Completion of 72 hours of antibiotic therapy 1
- No new skin lesions for 48 hours before competition 1
- No moist, exudative, or draining lesions at time of practice or competition 1
- Gram-stain of exudate for questionable lesions 1
- Cannot cover active purulent lesions to allow participation 1
NFHS (National Federation of State High School Associations) Requirements:
- Completion of 72 hours of antibiotic therapy with lesions resolving 1
- No moist, weeping, or draining lesions; all lesions should have well-adhering scabs 1
- Only scabbed and/or dry lesions can be covered with bio-occlusive dressing 1
NATA (National Athletic Trainers Association) Requirements:
- Completion of 72 hours of antibiotic therapy with lesions resolving 1
- No new skin lesions for at least 48 hours 1
- No moist, exudative, or draining lesions 1
Prevention Strategies
To prevent transmission of impetigo in athletic settings:
- Implement meticulous hygiene education and practices 1, 2
- Promptly identify and isolate infected individuals 1
- Limit exposure to infected people and contaminated surfaces/objects 1
- Properly clean and decontaminate the environment, especially high-touch surfaces 1
- Avoid sharing towels, equipment, and personal items 1, 2
- Ensure regular (daily, weekly, monthly) cleaning of facilities and equipment (weight rooms, railings, mats, locker rooms, showers) 1
- Screen athletes participating in contact sports during practices and before competitions 1
Treatment Approaches
Proper treatment is essential for both recovery and preventing transmission:
- For limited skin lesions: Topical mupirocin may be sufficient 1
- For more extensive infections: Systemic antibiotics are required 1
- First-line options include cephalexin, trimethoprim-sulfamethoxazole (TMP/SMX), or doxycycline based on susceptibility patterns 1
- For penicillin allergies: Azithromycin may be used 1
- Treatment duration is typically 10 days 1
- For MRSA concerns: Consider vancomycin or linezolid for severe infections 1
Risk Factors in Athletic Settings
Several factors increase the risk of impetigo transmission in sports:
- Contact sports with skin-to-skin contact (wrestling, football, rugby) 1, 2
- Skin breaks associated with turf burns or trauma 1
- Sharing of equipment or clothing (especially towels) 1
- Higher BMI 1
- Poor hygiene practices 1, 2
- Contaminated equipment and surfaces 1
Common Pitfalls to Avoid
- Allowing athletes to return to competition too early (before completing 72 hours of antibiotics) 1
- Covering active purulent lesions to allow participation 1
- Failing to properly clean and disinfect shared equipment 1
- Neglecting to screen athletes before competition 1
- Inadequate treatment of carriers during outbreaks 1
- Ignoring proper wound care and hygiene practices 1, 2