Impetigo Treatment Recommendations

First‑Line Therapy Based on Disease Extent

For patients with limited impetigo (few lesions), apply mupirocin 2 % ointment three times daily for 5–7 days; for extensive disease, facial or intertriginous involvement, or systemic symptoms, start oral antibiotics immediately. 1

Mupirocin 2 % ointment applied twice‑to‑three times daily is the most effective topical agent against both Staphylococcus aureus and Streptococcus pyogenes. 1
Retapamulin ointment applied twice daily is an acceptable alternative for patients with a small number of lesions. 1

When oral therapy is indicated, dicloxacillin, cephalexin, or amoxicillin‑clavulanate are recommended first‑line agents for presumed methicillin‑susceptible S. aureus (MSSA). 1
The typical treatment duration for MSSA‑targeted oral therapy is 5–10 days. 1

Clindamycin (300–450 mg three to four times daily in adults; weight‑based dosing in children) is preferred when local clindamycin resistance is < 10 %. 1
Trimethoprim‑sulfamethoxazole (double‑strength tablets twice daily in adults; weight‑based dosing in children) provides MRSA coverage but does not reliably treat streptococcal infection when used alone. 1
Doxycycline (100 mg twice daily) is an effective oral option for adults; it should be avoided in children younger than 8 years. 1
Recommended duration of MRSA‑active oral therapy is 7–10 days. 1

Doxycycline and all tetracyclines are contraindicated in children < 8 years because of safety concerns. 1

Macrolides (e.g., erythromycin) exhibit increasing resistance among impetigo pathogens and are no longer reliably effective. 1