From the Guidelines
Impetigo is best treated with topical antibiotics for mild cases and oral antibiotics for more severe or widespread infections, with mupirocin (Bactroban) 2% ointment applied three times daily for 5-7 days as the first-line treatment for localized impetigo, as recommended by the Infectious Diseases Society of America 1.
Treatment Options
For localized impetigo, the following treatment options are available:
- Mupirocin (Bactroban) 2% ointment applied three times daily for 5-7 days
- Retapamulin ointment applied twice daily
- For more extensive impetigo, oral antibiotics such as:
- Cephalexin (500 mg four times daily for adults, 25-50 mg/kg/day divided into four doses for children) for 7 days
- Dicloxacillin (250-500 mg four times daily for adults) for 7 days
- Amoxicillin-clavulanate
Important Considerations
- Gentle cleansing of the affected areas with warm water and mild soap before applying medication helps remove crusts and improves treatment effectiveness
- Patients should avoid touching or scratching the sores to prevent spreading the infection to other body parts or to other people
- Impetigo is highly contagious, so personal items like towels and bedding should not be shared
- The infection is caused by Staphylococcus aureus or Streptococcus pyogenes bacteria that enter through breaks in the skin, and prompt treatment is important to prevent complications such as cellulitis or, rarely, post-streptococcal glomerulonephritis, as noted in the guidelines 1
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 for mupirocin ointment in treating impetigo were 71% and 93% in two separate studies 2.
- Pathogen eradication rates for mupirocin ointment were 94% and 100% in the two studies 2.
- Mupirocin ointment can be used in pediatric patients, with clinical efficacy rates of 78% and 96% in two studies 2.
From the Research
Impetigo Treatment Overview
Impetigo is a common bacterial skin infection that can be treated with various methods. The treatment options include:
- Topical antibiotics such as mupirocin, retapamulin, and fusidic acid 3, 4
- Oral antibiotic therapy for extensive cases or when topical therapy is impractical 3, 5
- Natural therapies such as tea tree oil, olive oil, garlic oil, coconut oil, and Manuka honey, although their effectiveness is not well-established 3
Treatment Considerations
When choosing a treatment, it's essential to consider the following factors:
- The type of impetigo (nonbullous or bullous) 3, 5
- The presence of antibiotic-resistant bacteria, such as methicillin-resistant S. aureus (MRSA) 3, 4
- The extent of the infection (limited or extensive) 5, 4
- The potential for complications, such as poststreptococcal glomerulonephritis 3
Effectiveness of Treatment Options
Studies have shown that:
- Topical antibiotic treatment is effective in treating impetigo, with mupirocin and fusidic acid being equally effective 6
- Topical mupirocin is slightly superior to oral erythromycin 6
- Penicillin is inferior to other antibiotics, such as erythromycin and cloxacillin 6
- Disinfectant solutions are not effective in treating impetigo 6
Emerging Treatments
New treatments, such as minocycline foam and Ozenoxacin, are being developed to address the increasing prevalence of antibiotic-resistant bacteria 3