What steps can a patient with impetigo take using over-the-counter (OTC) medications, such as Neosporin (neomycin) or Bacitracin, to manage the infection and prevent its spread?

Over-the-Counter Management of Impetigo

For limited impetigo, over-the-counter triple antibiotic ointments like Neosporin or Bacitracin are NOT recommended as first-line treatment; instead, prescription topical mupirocin 2% ointment applied three times daily for 5-7 days is the evidence-based standard of care. 1, 2

Why OTC Products Are Inadequate

• Triple antibiotic ointments (Neosporin, Bacitracin) lack sufficient evidence for treating impetigo and are not mentioned in any major treatment guidelines from the Infectious Diseases Society of America or American Academy of Pediatrics 1, 2
• The FDA labeling for these products indicates general first-aid use for minor cuts and scrapes, not specifically for bacterial skin infections like impetigo 3, 4
• Topical disinfectants and non-prescription antibiotics are inferior to prescription antibiotics and should not be used as primary treatment 5

Prescription Topical Treatment (What You Actually Need)

• Mupirocin 2% ointment applied three times daily for 5-7 days is the first-line treatment recommended by the Infectious Diseases Society of America for limited lesions 1, 2
• Retapamulin 1% ointment applied twice daily for 5 days is an equally effective alternative 1, 2
• These prescription topicals have been proven superior to oral antibiotics in multiple studies with 575 participants, showing better cure rates (RR 2.24) compared to placebo 5

When Oral Antibiotics Are Necessary

Oral antibiotics should be used instead of topical treatment when: 1, 2, 6

• Multiple lesions are present across different body areas (extensive disease)
• Topical therapy is impractical to apply
• Topical treatment has failed after 48-72 hours
• Systemic symptoms are present (fever, malaise)
• There is an outbreak affecting multiple people (to decrease transmission)

For oral therapy: 1, 2

• Dicloxacillin or cephalexin (first-generation cephalosporin) for 7 days for methicillin-susceptible S. aureus
• Trimethoprim-sulfamethoxazole, clindamycin, or doxycycline if MRSA is suspected or confirmed

Wound Care and Coverage

Keep lesions covered with clean, dry bandages to prevent spread to others and other body sites 1, 6

• Simply covering with sterile gauze is the easiest and most effective approach 1
• Do NOT leave lesions uncovered as impetigo is highly contagious and spreads through direct contact 7, 8
• Clean the affected area before applying medication 3

Hygiene Measures to Prevent Spread

Critical hygiene practices include: 1

• Avoid sharing towels, clothing, or personal items
• Wash hands frequently with soap and water
• Keep fingernails trimmed short to prevent scratching and spreading
• Wash clothing, bedding, and towels in hot water daily during active infection
• Do not participate in contact sports or group activities until 24 hours after starting appropriate antibiotic therapy 1

Common Pitfalls

• Penicillin alone is NOT effective for impetigo as it lacks adequate coverage against S. aureus, which causes most cases 6, 7
• Do not rely on natural resolution—while impetigo may heal spontaneously in 2-3 weeks, treatment prevents spread, improves appearance, and reduces discomfort 7, 8
• If no improvement occurs after 48-72 hours of appropriate therapy, obtain cultures and consider MRSA or alternative diagnoses 6

Bottom Line Algorithm

1. For limited impetigo (few lesions): Obtain prescription mupirocin 2% ointment, apply three times daily for 5-7 days, and keep covered with clean bandages 1, 2
2. For extensive impetigo (multiple lesions): Obtain oral antibiotics (dicloxacillin or cephalexin) for 7 days 1, 2
3. If MRSA suspected: Use trimethoprim-sulfamethoxazole, clindamycin, or doxycycline 1, 2
4. Always maintain strict hygiene and keep lesions covered until healed 1, 6