From the Guidelines
Impetigo should be treated with either topical mupirocin or retapamulin twice daily for 5 days for mild cases, while oral therapy with an agent active against Staphylococcus aureus, such as cephalexin or dicloxacillin, is recommended for patients with numerous lesions or in outbreaks affecting several people.
Treatment Options
- For mild cases, topical mupirocin or retapamulin twice daily for 5 days is usually effective 1.
- For more extensive infections, oral antibiotics are recommended, with first-line options including cephalexin (500mg four times daily for adults, 25-50mg/kg/day divided into four doses for children) or dicloxacillin (250-500mg four times daily for adults) for 7 days 1.
- Alternatives for penicillin-allergic patients include clindamycin or trimethoprim-sulfamethoxazole 1.
Important Considerations
- Keep the affected areas clean by gently washing with warm water and mild soap, avoid scratching to prevent spread, and cover lesions with loose bandages if possible.
- Treatment is important because impetigo, caused primarily by Staphylococcus aureus or Streptococcus pyogenes bacteria, is highly contagious and can spread to other body parts or people through direct contact.
- Most cases resolve within 7-10 days with proper treatment, but consult a healthcare provider if the infection worsens or doesn't improve after 3-4 days of treatment.
Special Cases
- For patients with suspected or confirmed MRSA, doxycycline, clindamycin, or sulfamethoxazole-trimethoprim (SMX-TMP) is recommended 1.
- Systemic antimicrobials should be used for infections during outbreaks of poststreptococcal glomerulonephritis to help eliminate nephritogenic strains of Streptococcus pyogenes from the community 1.
From the FDA Drug Label
The efficacy of topical mupirocin ointment in impetigo was tested in two studies. Mupirocin ointment, 2% is indicated for the topical treatment of impetigo due to: Staphylococcus aureus and Streptococcus pyogenes.
Treatment for skin impetigo is mupirocin ointment, 2%, which is indicated for the topical treatment of impetigo due to Staphylococcus aureus and Streptococcus pyogenes 2 2.
- Clinical efficacy rates at end of therapy in the evaluable populations were 71% for mupirocin ointment and 35% for vehicle placebo in one study, and 93% for mupirocin ointment and 78.5% for erythromycin in another study.
- Pathogen eradication rates in the evaluable populations were 94% for mupirocin ointment and 62% for vehicle placebo in one study, and 100% for both test groups in another study.
From the Research
Treatment Options for Skin Impetigo
- Topical antibiotics such as mupirocin, retapamulin, and fusidic acid are effective treatments for skin impetigo 3, 4
- 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
- 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
- Treatments under development include minocycline foam and Ozenoxacin, a topical quinolone 3
Considerations for Empiric Treatment
- The increasing prevalence of antibiotic-resistant bacteria, including methicillin-resistant S. aureus, macrolide-resistant streptococcus, and mupirocin-resistant streptococcus, should be considered when selecting a treatment 3
- Fusidic acid, mupirocin, and retapamulin cover methicillin-susceptible S. aureus and streptococcal infections 3
- Clindamycin may be helpful in suspected methicillin-resistant S. aureus infections 3
- Trimethoprim/sulfamethoxazole covers methicillin-resistant S. aureus infection, but is inadequate for streptococcal infection 3