What is the treatment for impetigo in infants?

From the Guidelines

Impetigo in infants is best treated with a combination of gentle skin care and topical mupirocin (Bactroban) ointment applied twice daily for 5 days, as recommended by the Infectious Diseases Society of America 1. For mild cases with localized disease, this treatment approach is adequate in full-term neonates and young infants, according to the clinical practice guidelines by the Infectious Diseases Society of America 1. The ointment should be applied to affected areas after gently cleaning with warm water and mild soap to remove crusts. Some key points to consider in the treatment of impetigo in infants include:

• Keeping the infant's nails short to prevent scratching and spread of infection
• Using separate towels and washcloths
• Washing the infant's clothes, bedding, and toys in hot water
• Being aware that impetigo is highly contagious, caused primarily by Staphylococcus aureus or Streptococcus pyogenes bacteria that enter through breaks in the skin
• Understanding that most cases resolve completely with proper treatment, but untreated impetigo can lead to complications like cellulitis or, rarely, post-streptococcal glomerulonephritis, making prompt treatment important 1. For more extensive impetigo, oral antibiotics may be necessary, with cephalexin or amoxicillin-clavulanate being good options for infants, as suggested by various studies 1. However, the most recent and highest quality study recommends topical mupirocin or retapamulin twice daily for 5 days as the first-line treatment for bullous and nonbullous impetigo 1. It is essential to note that the treatment approach may vary depending on the severity of the disease and the presence of any underlying conditions. In general, the goal of treatment is to promote healing, prevent the spread of infection, and minimize the risk of complications, while also considering the potential risks and benefits of different treatment options 1.

From the FDA Drug Label

INDICATIONS AND USAGE Mupirocin ointment, 2% is indicated for the topical treatment of impetigo due to: Staphylococcus aureus and Streptococcus pyogenes. Mupirocin ointment, 2% can be used for the topical treatment of impetigo in infants, as it is indicated for the treatment of impetigo due to Staphylococcus aureus and Streptococcus pyogenes 2.

• The drug label does not specify an age limit for the treatment of impetigo.
• Mupirocin ointment, 2% is a topical treatment option for impetigo in infants.

From the Research

Impetigo Treatment in Infants

• Impetigo is a common bacterial skin infection that can affect infants, with two main types: nonbullous and bullous 3, 4, 5.
• The treatment for impetigo in infants typically involves topical antibiotics, such as mupirocin, fusidic acid, and retapamulin, which are effective against methicillin-susceptible Staphylococcus aureus and Streptococcus pyogenes 3, 4, 6, 7.
• For limited and uncomplicated impetigo, topical treatment is usually sufficient, while oral antibiotics may be necessary for more extensive or complicated cases 4, 6, 5.
• It is essential to consider the increasing prevalence of antibiotic-resistant bacteria, including methicillin-resistant S. aureus, when selecting a treatment option 3, 4, 6.
• Natural therapies, such as tea tree oil and Manuka honey, have been anecdotally successful but lack sufficient evidence to recommend or dismiss them as treatment options 3.
• The choice of topical antibiotic may depend on factors such as cost, insurance coverage, and the presence of resistant bacteria, with mupirocin ointment being a cost-effective option 7.

Topical Antibiotics for Impetigo

• Mupirocin, fusidic acid, and retapamulin are commonly used topical antibiotics for impetigo, with mupirocin being effective against MRSA 3, 4, 6, 7.
• Ozenoxacin is another effective alternative, but may be more expensive than other options 7.
• Retapamulin is indicated for lesions colonized by MSSA and Streptococcus pyogenes, but not MRSA, based on clinical efficacy in phase III trials 7.
• Fusidic acid is a non-FDA approved medication, but is available in other countries, with rising resistance rates being a growing concern 7.

Oral Antibiotics for Impetigo

• Oral antibiotics, such as amoxicillin-clavulanate, may be necessary for extensive or complicated impetigo, but should be used judiciously due to the risk of antibiotic resistance 3, 4, 6, 5.
• Clindamycin may be helpful in suspected methicillin-resistant S. aureus infections, while trimethoprim/sulfamethoxazole covers MRSA infection but is inadequate for streptococcal infection 3.