What is the treatment for scalp impetigo?

Treatment of Scalp Impetigo

For localized scalp impetigo, start with topical mupirocin 2% ointment applied three times daily for 5-7 days; for extensive disease involving multiple scalp sites, use oral antibiotics such as cephalexin or dicloxacillin for 5-10 days. 1

First-Line Treatment: Topical Antibiotics for Limited Disease

• Mupirocin 2% ointment applied three times daily for 5-7 days is the first-line treatment for localized scalp impetigo according to the American Academy of Dermatology 1
• This topical approach is FDA-approved for impetigo caused by Staphylococcus aureus and Streptococcus pyogenes 2
• Retapamulin 1% ointment applied twice daily for 5 days serves as an effective alternative for limited scalp lesions 3, 1
• Clinical efficacy rates for mupirocin reach 71-93% with pathogen eradication rates of 94-100% 2

Second-Line Treatment: Oral Antibiotics for Extensive Disease

Switch to oral antibiotics when:

• Impetigo is extensive or involves multiple sites on the scalp 1
• Topical therapy is impractical (hair makes application difficult) 1
• Topical treatment has failed after 48-72 hours 1
• Systemic symptoms are present 3, 1

For Methicillin-Susceptible S. aureus (MSSA):

• Dicloxacillin 250 mg four times daily for adults 1
• Cephalexin 250-500 mg four times daily for adults 1
• Dosing should be adjusted by weight for children 1
• Treatment duration is 5-10 days 1

For Suspected Methicillin-Resistant S. aureus (MRSA):

Consider MRSA coverage when there is:

• Failure to respond to first-line therapy 3
• High local prevalence of CA-MRSA 3
• Risk factors for CA-MRSA infection 3

MRSA treatment options:

• Clindamycin 300-450 mg three times daily for adults 1
• Trimethoprim-sulfamethoxazole (TMP-SMX) 3, 1
• Doxycycline (not for children under 8 years of age) 3, 1

Critical Pitfalls to Avoid

• Penicillin alone is not effective for impetigo as it lacks adequate coverage against S. aureus 1
• Tetracyclines (doxycycline, minocycline) should never be used in children under 8 years of age 1
• TMP-SMX covers MRSA but is inadequate for streptococcal infection, so ensure dual coverage 4

When to Obtain Cultures

• Treatment failure after appropriate therapy 1
• MRSA is suspected 1
• Recurrent infections 1
• Adjust antimicrobial therapy based on susceptibility results 1

Treatment Duration and Monitoring

• Re-evaluate if no improvement after 48-72 hours of therapy 1
• Complete the full course of prescribed antibiotics even if symptoms improve quickly to prevent complications such as post-streptococcal glomerulonephritis 3
• Keep lesions covered with clean, dry bandages and maintain good personal hygiene to prevent spread 1