From the Guidelines
The standard treatment duration for impetigo is 5 days for topical antimicrobials and 7 days for oral antimicrobials. For mild cases, topical antibiotics like mupirocin or retapamulin applied twice daily to affected areas is typically sufficient, as recommended by the Infectious Diseases Society of America 1. For more extensive or severe impetigo, oral antibiotics are recommended, with first-line options including dicloxacillin or cephalexin for 7 days, unless cultures yield streptococci alone, in which case oral penicillin is the recommended agent 1.
Key Considerations
- Treatment should continue for the full prescribed duration even if symptoms improve quickly to ensure complete eradication of the bacteria.
- Impetigo is highly contagious, so patients should wash affected areas gently with soap and water, avoid touching or scratching lesions, use separate towels and linens, and maintain good hand hygiene to prevent spread.
- The infection is typically caused by Staphylococcus aureus or Streptococcus pyogenes bacteria that enter through breaks in the skin, and prompt treatment helps prevent complications like cellulitis or post-streptococcal glomerulonephritis.
Treatment Options
- Topical mupirocin or retapamulin twice daily for 5 days for mild cases 1.
- Oral dicloxacillin or cephalexin for 7 days for more extensive or severe cases 1.
- Oral penicillin for 7 days if cultures yield streptococci alone 1.
- Alternatives for penicillin-allergic patients or infections with MRSA include doxycycline, clindamycin, or sulfamethoxazole-trimethoprim (SMX-TMP) 1.
From the FDA Drug Label
CLINICAL STUDIES The efficacy of topical mupirocin ointment in impetigo was tested in two studies. In the first, patients with impetigo were randomized to receive either mupirocin ointment or vehicle placebo t.i. d. for 8 to 12 days. In the second study, patients with impetigo were randomized to receive either mupirocin ointment t.i. d. or 30 to 40 mg/kg oral erythromycin ethylsuccinate per day (this was an unblinded study) for 8 days.
The treatment duration for impetigo with mupirocin ointment is 8 to 12 days in one study and 8 days in another study 2.
- The first study had a treatment duration of 8 to 12 days.
- The second study had a treatment duration of 8 days.
From the Research
Treatment Duration for Impetigo
The treatment duration for impetigo is typically around 7 days for topical antibiotics in systemically well patients with limited disease 3.
- Topical antibiotics such as mupirocin, fusidic acid, and retapamulin are effective treatments for impetigo 4, 5, 6.
- Oral antibiotics 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 4.
- The choice of antibiotic should consider the increasing prevalence of antibiotic-resistant bacteria, with methicillin-resistant S. aureus, macrolide-resistant streptococcus, and mupirocin-resistant streptococcus all documented 4.
- Topical disinfectants are inferior to antibiotics and should not be used 4, 6.
Specific Treatment Recommendations
- Topical mupirocin and fusidic acid are effective and may be superior to oral antibiotics for limited disease 3, 5, 6.
- Oral erythromycin is an alternative treatment option, although resistance rates are rising 7.
- Penicillin is not recommended due to its low efficacy compared to other antibiotics 6.