From the Guidelines
Impetigo treatment with lip involvement and subsequent spread requires prompt antibiotic therapy. The best treatment approach is to use either topical or oral antimicrobials, depending on the severity and extent of the infection [ 1 ].
Treatment Options
- For mild cases with limited lesions, topical mupirocin or retapamulin applied twice daily for 5 days is recommended [ 1 ].
- For more severe or widespread cases, including those with numerous lesions or outbreaks affecting several people, oral therapy is preferred to decrease transmission of infection [ 1 ].
Oral Antibiotic Regimens
- A 7-day regimen with an agent active against S. aureus, such as dicloxacillin or cephalexin, is recommended unless cultures yield streptococci alone, in which case oral penicillin is the recommended agent [ 1 ].
- If MRSA is suspected or confirmed, doxycycline, clindamycin, or sulfamethoxazole-trimethoprim (SMX-TMP) may be considered [ 1 ].
Key Considerations
- Gram stain and culture of the pus or exudates from skin lesions can help identify the causative organism, but treatment without these studies is reasonable in typical cases [ 1 ].
- Systemic antimicrobials may be necessary for infections during outbreaks of poststreptococcal glomerulonephritis to eliminate nephritogenic strains of Streptococcus pyogenes from the community [ 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.
The best treatment for impetigo with lip involvement and subsequent spread is topical mupirocin ointment.
- Clinical efficacy rates for mupirocin ointment in the treatment of impetigo were 71% to 96% in the studies 2.
- Pathogen eradication rates were 94% to 100% for mupirocin ointment 2.
- Mupirocin ointment is indicated for the topical treatment of impetigo due to Staphylococcus aureus and Streptococcus pyogenes 2.
From the Research
Treatment Options for Impetigo with Lip Involvement and Subsequent Spread
- Topical antibiotics such as mupirocin, retapamulin, and fusidic acid are effective treatments for impetigo, including cases with lip involvement and subsequent spread 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, 6
- Mupirocin has been shown to be a safe and effective alternative to oral antibiotic therapy in the treatment of impetigo, with similar clinical results to oral erythromycin and superior eradication of S aureus, including antibiotic-resistant S aureus 4, 5, 7
- Topical disinfectants are inferior to antibiotics and should not be used in the treatment of impetigo 3, 6
Considerations for Treatment
- 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
- 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
- Trimethoprim/sulfamethoxazole covers methicillin-resistant S aureus infection, but is inadequate for streptococcal infection 3