Treatment of Impetigo

For antibiotic therapy, the chosen agent must provide coverage against both Staphylococcus aureus and Streptococcus pyogenes

Limited impetigo — Topical therapy for impetigo should be administered if there are a limited number of lesions.

Topical therapy — Benefits of topical therapy include fewer side effects and lower risk for contributing to bacterial resistance compared with oral therapy. Mupirocin and retapamulin are first-line treatments. Retapamulin (available as Retarel*, Altargo*)  is  also effective against MRSA.

Mupirocin is applied in a thrice daily and retapamulin is applied as twice daily regime. The recommended length of treatment is five days.

Topical fusidic acid can be effective for impetigo; however, evidence for increasing resistance of S. aureus to fusidic acid in locations where topical fusidic acid use is common has made it a less favorable option for therapy.

Extensive impetigo and ecthyma — Oral therapy should be administered to patients with numerous impetigo lesions or ecthyma.

In patient care is required for patients with impetigo who have widespread disease or for infants at risk of sepsis and/or dehydration due to skin loss.

Systemic antibiotics —  

Cephalexin or Dicloxacillin appear to be the drugs of choice for oral antimicrobial therapy in children. If MRSA is suspected, alternative antibiotics include clindamycin, trimethoprim/sulfamethoxazole, Linezolid and doxycycline .

Erythromycin and clindamycin are alternatives in patients with penicillin hypersensitivity

A seven-day course of oral antibiotic treatment is recommended

Practice points

Treatment of impetigo with systemic antibiotics does not prevent the development of a poststreptococcal glomerulonephritis

For patients with recurrent impetigo, asymptomatic family members, and S aureus nasal carriers, prescribe 2% mupirocin cream or ointment for application inside nostrils and axillae, 3 times per day for 5 days each month to reduce colonization in the nose.

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