What is the treatment for impetigo?

From the Guidelines

Impetigo should be treated with either topical mupirocin or retapamulin twice daily for 5 days for mild cases, while oral therapy is recommended for patients with numerous lesions or in outbreaks affecting several people. When considering treatment options, it's essential to identify the cause of impetigo, which can be either Staphylococcus aureus or β-hemolytic Streptococcus 1. Some key points to consider when treating impetigo include:

• Treatment without culture or gram stain is reasonable in typical cases, but these tests can help identify the cause of the infection 1
• Oral therapy should be used for patients with numerous lesions or in outbreaks affecting several people to help decrease transmission of infection 1
• Topical mupirocin or retapamulin are recommended for 5 days for bullous and nonbullous impetigo 1
• Oral therapy for ecthyma or impetigo should be a 7-day regimen with an agent active against S. aureus, such as dicloxacillin or cephalexin, unless cultures yield streptococci alone, in which case oral penicillin is recommended 1
• When MRSA is suspected or confirmed, doxycycline, clindamycin, or sulfamethoxazole-trimethoprim (SMX-TMP) is recommended 1 It's also crucial to practice good hygiene, such as gently washing the affected areas with soap and water, removing crusts before applying medication, and avoiding touching or scratching the sores to prevent spreading the infection to other body parts or people. Proper hygiene and completing the full course of antibiotics are essential for effective treatment and preventing the spread of impetigo 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 Options

• Impetigo is a highly contagious, superficial skin infection that can be treated with various antibiotics and therapies 3, 4, 5, 6, 7.
• The two principal types of impetigo are nonbullous (70% of cases) and bullous (30% of cases), with nonbullous impetigo being caused by Staphylococcus aureus or Streptococcus pyogenes 3.

Topical Antibiotics

• Topical antibiotics such as mupirocin, retapamulin, and fusidic acid are effective in treating impetigo 3, 4, 5, 7.
• Mupirocin and fusidic acid have been shown to be equally effective, with a pooled risk ratio (RR) of 1.03 (95% CI 0.95 to 1.11) in 4 studies with 440 participants 4.
• Topical mupirocin has been shown to be slightly superior to oral erythromycin, with a pooled RR of 1.07 (95% CI 1.01 to 1.13) in 10 studies with 581 participants 4.

Oral Antibiotics

• Oral antibiotics such as amoxicillin/clavulanate, dicloxacillin, cephalexin, clindamycin, doxycycline, minocycline, trimethoprim/sulfamethoxazole, and macrolides can be used to treat impetigo, especially in cases with large bullae or when topical therapy is impractical 3, 6.
• Penicillin is not recommended as a treatment option due to its inferior efficacy compared to other antibiotics 3, 6.

Natural Therapies and Disinfectants

• 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.
• Topical disinfectants are inferior to antibiotics and should not be used, with a pooled RR of 1.15 (95% CI 1.01 to 1.32) in 2 studies with 292 participants 4.

Resistance and Treatment Considerations

• 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 option 3, 7.
• Fusidic acid, mupirocin, and retapamulin cover methicillin-susceptible S. aureus and streptococcal infections, while clindamycin is helpful in suspected methicillin-resistant S. aureus infections 3.