Erythromycin Ointment Dosing for Superficial Skin Infections
For impetigo and limited superficial skin infections, apply erythromycin ointment (typically mupirocin or retapamulin are preferred, but when erythromycin ointment is used) to affected lesions twice daily (BID). 1
Topical Application Guidelines
- Apply the ointment directly to lesions twice daily (morning and evening) after thoroughly washing the affected area with warm water and soap, then patting dry 2
- The ointment can be applied to lesions on the face, neck, shoulders, chest, and back 2
- Use the applicator top for application; if using fingertips, wash hands immediately after application 2
- Duration of treatment is typically 7-10 days depending on clinical response 1
Important Clinical Context
Topical erythromycin ointment is reserved for patients with a limited number of lesions and is not appropriate for extensive or systemic infections 1
When Topical Therapy is Appropriate:
- Localized impetigo with few lesions 1
- Superficial skin infections without systemic signs 1
- Patients who cannot tolerate or access systemic antibiotics 1
When Systemic Therapy is Required Instead:
- Multiple or widespread lesions requiring systemic antibiotics 1
- Presence of systemic signs (fever >38°C, tachycardia >90 bpm) 1
- Deeper tissue involvement beyond superficial skin 1
Critical Caveats
Resistance is a significant concern: Some strains of Staphylococcus aureus and Streptococcus pyogenes may be resistant to erythromycin 1
- Mupirocin or retapamulin ointments are generally preferred over erythromycin for topical treatment of impetigo due to better efficacy and lower resistance rates 1
- If drying and peeling occur with topical erythromycin, reduce application frequency 2
- Consider switching to systemic therapy if no improvement occurs within 48-72 hours 1