Topical Antibiotic Treatment for Impetigo
Mupirocin 2% ointment applied three times daily for 5-7 days is the first-line topical antibiotic treatment for impetigo.
First-Line Topical Therapy
- Mupirocin 2% ointment is the gold standard topical agent for impetigo, with FDA approval specifically for treating impetigo caused by Staphylococcus aureus and Streptococcus pyogenes 1
- Apply mupirocin 2% ointment three times daily for 5-7 days to affected areas 2, 3, 4
- Clinical efficacy rates range from 71-93% in controlled trials, making it superior to many alternatives 2
- The ointment formulation provides better adherence to moist skin and maintains longer contact time with infected areas compared to cream formulations 3
Alternative Topical Option
- Retapamulin 1% ointment applied twice daily for 5 days is an effective alternative if mupirocin is unavailable or has failed 2, 3, 4
- Retapamulin is FDA-approved for impetigo in patients aged 9 months or older, but only covers methicillin-susceptible S. aureus 5
Critical Pitfalls to Avoid
- Do not use bacitracin or neomycin as they are considerably less effective and should be avoided 2
- Topical disinfectants are not useful in treating impetigo 6
- Avoid penicillin alone as it lacks adequate coverage against S. aureus 2, 4
When to Escalate to Oral Antibiotics
Re-evaluate after 48-72 hours and switch to oral antibiotics if 2, 3, 4:
- No improvement with topical therapy
- Impetigo is extensive or involves multiple sites
- Systemic symptoms develop (fever, malaise, lymphadenopathy)
- Topical therapy is impractical
Oral Antibiotic Options for MSSA:
- Dicloxacillin 250 mg four times daily for adults 2, 4
- Cephalexin 250-500 mg four times daily for adults 2, 4
Oral Antibiotic Options for MRSA:
- Clindamycin 300-450 mg three times daily for adults 2, 4
- Trimethoprim-sulfamethoxazole (TMP-SMX) 1-2 double-strength tablets twice daily 2, 4