From the Guidelines
Impetigo should be treated with either topical mupirocin or retapamulin twice daily for 5 days for mild cases, while oral therapy is recommended for patients with numerous lesions or in outbreaks affecting several people. When considering treatment options, it's essential to note that gram stain and culture of the pus or exudates from skin lesions can help identify the cause, but treatment without these studies is reasonable in typical cases 1. For bullous and nonbullous impetigo, topical antimicrobials are a viable option, but oral therapy is preferred for more severe cases or outbreaks to decrease transmission of infection. Some key points to consider when treating impetigo include:
- Topical mupirocin or retapamulin twice daily for 5 days is recommended for mild cases (strong, high) 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 (when oral penicillin is the recommended agent) 1
- When MRSA is suspected or confirmed, doxycycline, clindamycin, or sulfamethoxazole-trimethoprim (SMX-TMP) is recommended 1 It's also crucial to practice good hygiene, such as gently washing the affected areas with soap and water 2-3 times daily to remove crusts, and avoiding touching or scratching the sores to prevent spread.
From the FDA Drug Label
CLINICAL STUDIES The efficacy of topical mupirocin ointment in impetigo was tested in two studies. INDICATIONS AND USAGE Mupirocin ointment, 2% is indicated for the topical treatment of impetigo due to: Staphylococcus aureus and Streptococcus pyogenes.
Impetigo Treatment: Mupirocin ointment is indicated for the topical treatment of impetigo due to Staphylococcus aureus and Streptococcus pyogenes 2, 2.
- Clinical Efficacy Rates:
- Pathogen Eradication Rates:
From the Research
Impetigo Treatment Options
- Impetigo is a highly contagious, superficial skin infection that can be treated with topical or oral antibiotics 3, 4, 5, 6, 7.
- Topical antibiotics such as mupirocin, retapamulin, and fusidic acid are effective in treating impetigo, especially for limited disease 3, 6, 7.
- Oral antibiotic therapy can be used for impetigo with large bullae or when topical therapy is impractical, with options including amoxicillin/clavulanate, dicloxacillin, cephalexin, clindamycin, doxycycline, minocycline, trimethoprim/sulfamethoxazole, and macrolides 3, 4, 7.
- Penicillin is not a recommended treatment option due to its low efficacy compared to other antibiotics 4, 6.
Considerations for Treatment
- The increasing prevalence of antibiotic-resistant bacteria, such as methicillin-resistant S. aureus, macrolide-resistant streptococcus, and mupirocin-resistant streptococcus, should be taken into account when choosing a treatment option 3.
- Topical disinfectants are not recommended as they are inferior to antibiotics and may not effectively treat impetigo 3, 7.
- Natural therapies such as tea tree oil, olive oil, garlic oil, coconut oil, and Manuka honey have been anecdotally successful, but lack sufficient evidence to recommend or dismiss them as treatment options 3.
Treatment Guidelines
- The choice of treatment should be based on the severity and extent of the disease, as well as the patient's preferences and potential allergies 5, 7.
- Topical antibiotics are generally recommended for limited disease, while oral antibiotics may be necessary for more extensive disease 6, 7.
- Treatment should be tailored to the individual patient, taking into account the potential for antibiotic resistance and the need for effective treatment to prevent the spread of the infection 3, 4, 5, 6, 7.