From the Guidelines
For pediatric impetigo treatment, oral cephalexin is recommended at 25-50 mg/kg/day divided into 3-4 doses for 7 days, as stated in the 2014 update by the Infectious Diseases Society of America 1. This recommendation is based on the most recent and highest quality evidence available. The dosage of cephalexin is weight-based, and it is essential to follow the recommended dosage to ensure accurate treatment.
- Alternative treatment options include amoxicillin-clavulanate at 25 mg/kg/day of the amoxicillin component in 2 divided doses for 7 days, as well as topical treatment with mupirocin 2% ointment applied three times daily for 5-7 days for limited lesions.
- For MRSA concerns, clindamycin at 20 mg/kg/day in 3 divided doses for 7 days can be considered, as it is an important option for children.
- Impetigo, caused primarily by Staphylococcus aureus and Streptococcus pyogenes, requires prompt treatment to prevent spread and complications.
- Good hygiene practices, including daily bathing with antibacterial soap, keeping fingernails short, and avoiding sharing personal items, help prevent spread to other body areas and to other children. The 2014 guidelines provide the most up-to-date recommendations for the treatment of impetigo, and following these guidelines can help improve patient outcomes and reduce the risk of complications 1.
From the Research
Impetigo Pediatric Dosing
- The treatment of impetigo in pediatric patients can be achieved through topical antibiotics for localized lesions, while oral antibiotics are reserved for extensive disease 2.
- Topical antibiotics such as mupirocin, retapamulin, and fusidic acid are effective in treating impetigo, and may be superior to oral antibiotics in some cases 3, 4, 5.
- 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, 4, 6.
- However, penicillin is not a recommended treatment option due to its limited effectiveness against certain strains of bacteria 3, 4.
- Antimicrobial stewardship is critical to optimize patient outcomes and prevent the development of resistance, and healthcare providers should be aware of local resistance patterns in impetigo to guide therapy 2.
Treatment Considerations
- The increasing prevalence of antibiotic-resistant bacteria, including methicillin-resistant S. aureus, macrolide-resistant streptococcus, and mupirocin-resistant streptococcus, has changed empiric treatment considerations 3.
- Fusidic acid, mupirocin, and retapamulin are effective against methicillin-susceptible S. aureus and streptococcal infections, while 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.