Bacitracin is NOT Recommended for Treating Mild Impetigo
Bacitracin should not be used to treat mild impetigo—instead, use topical mupirocin 2% ointment applied three times daily for 5-7 days as the first-line treatment. 1
Why Bacitracin is Inappropriate
- Bacitracin has a narrow antibacterial spectrum and is associated with treatment failure and sensitization when used topically for bacterial skin infections 2
- Bacitracin is not mentioned in any current clinical practice guidelines for impetigo treatment, indicating it lacks sufficient efficacy for this indication 3, 1, 4
Recommended First-Line Treatment for Mild Impetigo
For localized, mild impetigo, topical mupirocin 2% ointment applied three times daily for 5-7 days is the evidence-based first-line treatment 3, 1
Alternative Topical Options
- Retapamulin 1% ointment applied twice daily for 5 days is an effective alternative for limited impetigo 1
- Both mupirocin and retapamulin provide excellent coverage against Staphylococcus aureus and Streptococcus pyogenes, the causative organisms in impetigo 4, 2
When to Use Oral Antibiotics Instead
Oral antibiotics should be used when: 1, 4
- Impetigo is extensive or involves multiple sites
- Topical therapy is impractical
- Treatment with topical antibiotics has failed
- Systemic symptoms are present
Oral Antibiotic Options
- For MSSA: Dicloxacillin 250 mg four times daily or cephalexin 250-500 mg four times daily 1
- For MRSA: Clindamycin 300-450 mg three times daily, trimethoprim-sulfamethoxazole, or doxycycline (not for children under 8 years) 1
Critical Pitfalls to Avoid
- Never use penicillin alone for impetigo as it lacks adequate coverage against S. aureus 1, 4
- Topical disinfectants are inferior to antibiotics and should not be used 4
- Bacitracin may produce treatment failure and sensitization, making it an inappropriate choice 2