From the Guidelines
Impetigo treatment should involve topical mupirocin or retapamulin twice daily for 5 days for bullous and nonbullous cases, as recommended by the Infectious Diseases Society of America 1.
Key Considerations
- The choice of treatment depends on the severity of the infection and the number of lesions.
- For patients with numerous lesions or in outbreaks affecting several people, oral therapy is recommended to help decrease transmission of infection 1.
- Oral therapy for ecthyma or impetigo should be a 7-day regimen with an agent active against S. aureus, such as dicloxacillin or cephalexin, unless cultures yield streptococci alone, in which case oral penicillin is recommended 1.
Treatment Options
- Topical mupirocin or retapamulin twice daily for 5 days is recommended for bullous and nonbullous impetigo 1.
- Oral antibiotics, such as cephalexin or dicloxacillin, are recommended for more extensive infections or in cases where topical treatment is not sufficient 1.
- Alternative oral antibiotics, such as clindamycin or sulfamethoxazole-trimethoprim, may be used in patients with penicillin allergies or in cases of methicillin-resistant S. aureus (MRSA) 1.
Additional Measures
- Proper wound care, including gentle washing with soap and water to remove crusts before applying topical antibiotics, is essential 1.
- Patients should avoid touching or scratching the lesions to prevent spread, and should use separate towels and linens until the infection resolves 1.
From the FDA Drug Label
Skin and skin structure infections of mild to moderate severity caused by Streptococcus pyogenes or Staphylococcus aureus (resistant staphylococci may emerge during treatment). Erythromycin tablets are indicated for the treatment of skin and skin structure infections, including those caused by Streptococcus pyogenes and Staphylococcus aureus, which are common causes of impetigo.
- Impetigo can be treated with erythromycin tablets, as they are effective against the susceptible strains of microorganisms that cause this infection 2.
From the Research
Impetigo Overview
- Impetigo is a highly contagious bacterial skin infection that most commonly affects children two to five years of age 3, 4.
- There are two principal types of impetigo: nonbullous (70% of cases) and bullous (30% of cases) 3.
- Nonbullous impetigo is caused by Staphylococcus aureus or Streptococcus pyogenes, while bullous impetigo is caused exclusively by S. aureus 3.
Treatment Options
- Topical antibiotics such as mupirocin, retapamulin, and fusidic acid are effective in treating impetigo 3, 4, 5.
- Oral antibiotic therapy can be used for impetigo with large bullae or when topical therapy is impractical 3, 6.
- Amoxicillin/clavulanate, dicloxacillin, cephalexin, clindamycin, doxycycline, minocycline, trimethoprim/sulfamethoxazole, and macrolides are options for oral antibiotic therapy 3, 6.
- Natural therapies such as tea tree oil, olive, garlic, and coconut oils, and Manuka honey have been anecdotally successful, but lack sufficient evidence to recommend or dismiss them as treatment options 3.
Antibiotic Resistance
- The increasing prevalence of antibiotic-resistant bacteria is a concern in the treatment of impetigo 3, 7.
- Methicillin-resistant S. aureus, macrolide-resistant streptococcus, and mupirocin-resistant streptococcus have been documented 3.
- Fusidic acid, mupirocin, and retapamulin cover methicillin-susceptible S. aureus and streptococcal infections, while clindamycin is helpful in suspected methicillin-resistant S. aureus infections 3.
- Trimethoprim/sulfamethoxazole covers methicillin-resistant S. aureus infection, but is inadequate for streptococcal infection 3.
Future Directions
- There is a need for new topical antimicrobials and antiseptics as an alternative treatment strategy for impetigo 7.
- Additional research is required to ascertain the usefulness of alternative agents, including new topical antimicrobials and antiseptics 7.
- A comparative review of current topical antibiotics for impetigo found that mupirocin, ozenoxacin, and retapamulin are effective alternatives, but may entail higher cost 5.