From the Guidelines
Impetigo should be treated with either topical mupirocin or retapamulin twice daily for 5 days for bullous and nonbullous cases, as recommended by the Infectious Diseases Society of America 1. When considering treatment options, it's essential to prioritize the most recent and highest quality evidence to minimize morbidity, mortality, and improve quality of life. The treatment approach may vary depending on the severity of the infection and the presence of multiple lesions or outbreaks. Key considerations include:
- Topical antimicrobials, such as mupirocin or retapamulin, are recommended for typical cases of impetigo 1.
- Oral therapy, such as dicloxacillin or cephalexin, is recommended for patients with numerous lesions or in outbreaks affecting several people to help decrease transmission of infection 1.
- Treatment for ecthyma should be an oral antimicrobial, and oral penicillin is the recommended agent when cultures yield streptococci alone 1.
- When MRSA is suspected or confirmed, doxycycline, clindamycin, or sulfamethoxazole-trimethoprim (SMX-TMP) is recommended 1. It's crucial to follow the recommended treatment guidelines to ensure effective management of impetigo and prevent potential complications.
From the FDA Drug Label
Mupirocin ointment, 2% is indicated for the topical treatment of impetigo due to: Staphylococcus aureus and Streptococcus pyogenes. The efficacy of topical mupirocin ointment in impetigo was tested in two studies. Impetigo Treatment:
- Mupirocin ointment is indicated for the topical treatment of impetigo due to Staphylococcus aureus and Streptococcus pyogenes 2.
- Clinical efficacy rates at end of therapy in the evaluable populations were 71% for mupirocin ointment and 35% for vehicle placebo 2.
- Clinical efficacy rates at the follow-up visit in the evaluable populations were 93% for mupirocin ointment and 78.5% for erythromycin 2. Key Points:
- Mupirocin ointment is effective in treating impetigo caused by Staphylococcus aureus and Streptococcus pyogenes 2.
From the Research
Treatment Options for Impetigo
- Topical antibiotics such as mupirocin, retapamulin, and fusidic acid are effective in treating impetigo 3, 4, 5, 6, 7
- 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
Comparison of Treatment Options
- Topical antibiotics are more effective than placebo in treating impetigo 5
- Topical mupirocin is as effective as oral erythromycin therapy in treating impetigo 6
- Topical mupirocin is superior to oral erythromycin in eradicating S. aureus, including antibiotic-resistant S. aureus 6
- Topical mupirocin has a similar clinical response to oral flucloxacillin in treating skin infections, including impetigo 7
Considerations for Treatment
- Empiric treatment considerations have changed with the increasing prevalence of antibiotic-resistant bacteria, including methicillin-resistant S. aureus, macrolide-resistant streptococcus, and mupirocin-resistant streptococcus 3
- Fusidic acid, mupirocin, and retapamulin cover methicillin-susceptible S. aureus and streptococcal infections 3
- Clindamycin is helpful in suspected methicillin-resistant S. aureus infections 3
- Trimethoprim/sulfamethoxazole covers methicillin-resistant S. aureus infection, but is inadequate for streptococcal infection 3