Management of Skin Infections

Diagnosis and Treatment

For patients with skin infections, including impetigo, obtain cultures from active lesions to identify the causative organism and antibiotic sensitivities, as recommended by the Infectious Diseases Society of America 1
Treatment can begin before culture results in typical cases, and clinical response to treatment should be evaluated within 48-72 hours, with alternative antibiotics considered if no improvement is seen within 3-5 days 1, 2, 3, 4
First-line treatment options include:
The standard duration of oral antibiotic therapy is 7 days 1, 3
The American College of Physicians recommends the following dosages:

Topical treatment options include:
The American College of Physicians recommends topical mupirocin for limited, localized lesions, applied 3 times daily for 5-7 days 5

Good personal hygiene practices, such as regular handwashing, keeping draining wounds covered, and avoiding sharing personal items, are essential for preventing the spread of impetigo 4, 6
Focusing cleaning on high-touch surfaces can also help reduce the risk of infection, and good hygiene practices are essential to prevent the spread of impetigo, including keeping lesions covered when possible, using separate towels and linens, and practicing good hand hygiene 2, 5, 6
A 5-day decolonization regimen, including intranasal mupirocin twice daily, daily chlorhexidine washes, and daily decontamination of personal items, may be effective in preventing recurrent infections 1

Complications of impetigo are rare, with poststreptococcal glomerulonephritis being the most serious, occurring in less than 1 case per 1,000,000 population per year 2, 7, 8, 9
Common pitfalls to avoid include:

If a patient with impetigo has an elevated eosinophil count, consider treating impetigo as usual and additional investigation for potential parasitic infections or other causes of eosinophilia, including stool examination for ova and parasites and serology for parasitic infections based on travel history 7, 8
Consider evaluation for underlying immunodeficiency or neutrophil disorders if recurrence happens more than 3 times, according to the Infectious Diseases Society of America 1
Prophylactic antibiotics may be considered for patients with frequent recurrences (3-4 episodes per year), as suggested by the Infectious Diseases Society of America 1
Tetracyclines, such as doxycycline and minocycline, should not be used in children under 8 years of age, as recommended by the Infectious Diseases Society of America 10
For suspected MRSA, the Infectious Diseases Society of America recommends Clindamycin: 10-20 mg/kg/day in 3 divided doses, or Trimethoprim-sulfamethoxazole (TMP-SMX): 8-12 mg/kg/day (based on trimethoprim) in 2 divided doses 10