Treatment of Non-Bullous Impetigo

Initial Assessment and Treatment Selection

• The Infectious Diseases Society of America recommends topical mupirocin 2% ointment applied three times daily for 5-7 days as the first-line treatment for localized impetigo 1, 2
• Retapamulin applied twice daily for 5 days is an alternative topical option 2
• Oral antibiotics, such as dicloxacillin or cephalexin, should be used for extensive disease, numerous lesions, or when topical therapy is impractical 1, 2, 4

Oral Antibiotic Regimens

• For presumed methicillin-susceptible S. aureus (MSSA), dicloxacillin 250 mg four times daily for adults (7-10 days) is a recommended oral option 1, 2, 4
• Cephalexin 250-500 mg four times daily for adults (7-10 days) is also a recommended oral option for MSSA 1, 2, 4
• For suspected or confirmed MRSA, clindamycin 300-450 mg three times daily for adults is a recommended option 1, 2, 4

Culture Guidance

• Gram stain and culture of pus or exudates are recommended to identify the cause of impetigo, but treatment without these studies is reasonable in typical cases 2

Duration of Therapy

• Topical treatment should be used for 5-7 days 2, 4
• Oral antibiotics should be used for 7-10 days 1, 2, 4

Special Populations

• In pediatric patients, dicloxacillin can be used at a dose of 12 mg/kg/day in 4 divided doses 3
• Tetracyclines, such as doxycycline, should be avoided in children under 8 years and pregnant women 4, 3

Prevention of Spread

• Lesions should be kept covered with clean, dry bandages to prevent the spread of impetigo 4, 3
• Good personal hygiene with regular handwashing is also important to prevent the spread of impetigo 4

Monitoring and Follow-Up

• Patients should be re-evaluated if there is no improvement after 48-72 hours of therapy 3