From the Guidelines
The best treatment for impetigo that started on the lips and spread to the bilateral cheeks and eyelids is a topical antibiotic ointment, such as mupirocin 2% applied twice daily for 5 days 1.
Treatment Options
- For more severe cases or those with significant facial involvement, oral antibiotics may be necessary, with dicloxacillin 250mg orally four times daily or cephalexin 500mg orally three times daily for 7 days being suitable options 1.
- In cases where the eyelids are involved, careful attention to hygiene and application of the antibiotic ointment to the affected areas is crucial to prevent further spread and promote healing.
Key Considerations
- Gram stain and culture of the pus or exudates from skin lesions of impetigo are recommended to help identify the cause, but treatment without these studies is reasonable in typical cases 1.
- Oral therapy is recommended for patients with numerous lesions or in outbreaks affecting several people to help decrease transmission of infection 1.
- MRSA should be suspected or confirmed, and treated with doxycycline, clindamycin, or sulfamethoxazole-trimethoprim (SMX-TMP) 1.
- The choice of antibiotic should be based on the severity of the infection, the presence of systemic symptoms, and the potential for resistance 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 that started on the lips and spread to the bilateral cheeks and eyelids is topical mupirocin ointment.
- Clinical efficacy rates for mupirocin ointment in the treatment of impetigo were 71% to 96% in the studies 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
The treatment for impetigo, a superficial bacterial skin infection, can vary depending on the severity and extent of the infection. For impetigo that started on the lips and spread to the bilateral cheeks and eyelids, the following treatment options are available:
- Topical antibiotic treatment, such as mupirocin or fusidic acid, which has been shown to be effective in treating impetigo 3
- Topical ozenoxacin cream 1%, which has been found to be a safe and effective treatment option for impetigo, including cases with methicillin-resistant Staphylococcus aureus (MRSA) 4
- Oral antibiotics, such as erythromycin or cloxacillin, which may be prescribed for more severe cases of impetigo, although they may have a higher risk of side effects compared to topical treatments 3, 5
Considerations for Treatment
When selecting a treatment for impetigo, it is essential to consider the following factors:
- Antimicrobial resistance patterns, as the prevalence of resistant strains of Staphylococcus aureus and Streptococcus pyogenes is increasing 4, 6
- The severity and extent of the infection, as well as the patient's age and immune status 6
- The potential for side effects and the risk of adverse reactions, particularly with oral antibiotics 3, 5
Treatment Algorithms
An evidence-based treatment algorithm for impetigo has been developed, which takes into account antimicrobial stewardship and the increasing resistance to oral and topical antibiotics 6. This algorithm recommends education and prevention, diagnosis and classification, treatment measures, and follow-up, and distinguishes between localized and widespread or epidemic outbreaks of impetigo.