From the Guidelines
For impetigo, strep pyogenes, or staph skin infections, the first-line treatment is typically topical mupirocin or retapamulin twice daily for 5 days, as recommended by the Infectious Diseases Society of America 1.
Key Considerations
- The choice of antibiotic depends on the severity of the infection and the suspected causative organism.
- For more extensive infections, oral antibiotics such as cephalexin or dicloxacillin may be recommended for 7 days 1.
- In cases where MRSA is suspected or confirmed, alternative antibiotics such as doxycycline, clindamycin, or sulfamethoxazole-trimethoprim may be used 1.
- Good wound care, including gentle washing with soap and water, keeping the area clean, and covering with a bandage if draining, is essential alongside antibiotic therapy.
Treatment Options
- Topical mupirocin or retapamulin for 5 days for mild to moderate infections 1.
- Oral cephalexin or dicloxacillin for 7 days for more extensive infections 1.
- Alternative antibiotics such as doxycycline, clindamycin, or sulfamethoxazole-trimethoprim for suspected or confirmed MRSA infections 1.
Important Notes
- Patients should complete the full course of antibiotics even if symptoms improve quickly to prevent recurrence and antibiotic resistance.
- The treatment of impetigo, strep pyogenes, or staph skin infections should be guided by the most recent and highest quality evidence, which recommends topical mupirocin or retapamulin as first-line treatment 1.
From the FDA Drug Label
Mupirocin ointment, 2% is indicated for the topical treatment of impetigo due to: Staphylococcus aureus and Streptococcus pyogenes. The first line treatment for impetigo, strep pyogenes infection, or staph skin infection is mupirocin ointment, 2% 2.
- Key points:
- Indicated for topical treatment of impetigo due to Staphylococcus aureus and Streptococcus pyogenes
- Effective in clinical studies with high clinical efficacy rates and pathogen eradication rates 2
From the Research
First Line Treatment for Impetigo, Strep Pyogenes Infection, or Staph Skin Infection
- The first line treatment for impetigo, strep pyogenes infection, or staph skin infection is topical antibiotics such as mupirocin, retapamulin, and fusidic acid 3, 4.
- For nonbullous impetigo, topical treatment is usually sufficient, while oral antibiotic therapy may be necessary for bullous impetigo or when topical therapy is impractical 3, 5.
- Oral antibiotics such as amoxicillin/clavulanate, dicloxacillin, cephalexin, clindamycin, doxycycline, minocycline, trimethoprim/sulfamethoxazole, and macrolides may be used, but penicillin is not effective 3.
- The choice of antibiotic should take into account the increasing prevalence of antibiotic-resistant bacteria, including methicillin-resistant S. aureus, macrolide-resistant streptococcus, and mupirocin-resistant streptococcus 3, 6.
- Topical retapamulin has been shown to be effective in the treatment of impetigo and other uncomplicated superficial skin infections caused by S. aureus and S. pyogenes 4.