Return to School and Sports After Bullous Impetigo

Treatment Requirements Before Return

Individuals with bullous impetigo should not return to school or sports until they have completed at least 24 hours of appropriate antibiotic therapy AND have no moist, weeping, or draining lesions, as recommended by the American Academy of Pediatrics 1
Completion of at least 72 hours of appropriate antibiotic therapy with visible signs of lesion resolution is required before returning to school or competitive activities, according to the American Academy of Pediatrics 1
No new skin lesions should be present for at least 48 hours before returning to school or competitive activities, as stated by the American Academy of Pediatrics 1
All lesions must be dry with well-adhering scabs; no moist, exudative, or draining lesions should be present at the time of return, as recommended by the American Academy of Pediatrics 1

Topical mupirocin may be used for localized and non-bullous impetigo, as suggested by the American Academy of Pediatrics 2
For methicillin-resistant S. aureus (MRSA), alternatives include trimethoprim-sulfamethoxazole, doxycycline, or clindamycin for susceptible isolates, according to the American Academy of Pediatrics 2

Monitor for complete drying of all lesions and formation of firm, adherent crusts, as recommended by the American Academy of Pediatrics 1
Ensure no new lesions have developed for at least 48 hours before returning to school, as stated by the American Academy of Pediatrics 1

Athletes with skin infections should not return to competitive sports for at least 24 hours after beginning appropriate oral antimicrobial therapy, as recommended by the American Academy of Pediatrics 3
National Collegiate Athletic Association (NCAA) and National Federation of State High School Associations (NFHS) guidelines specify completion of 72 hours of antibiotic therapy with lesions resolving, as stated by the American Academy of Pediatrics 1
National Collegiate Athletic Association (NCAA) and National Federation of State High School Associations (NFHS) guidelines specify no moist or draining lesions; all lesions should have well-adhering scabs, according to the American Academy of Pediatrics 1
Scabbed and/or dry lesions only can be covered with bio-occlusive dressing, as recommended by the American Academy of Pediatrics 1

Active purulent lesions cannot be covered to allow participation; the athlete must be excluded until properly treated, as stated by the American Academy of Pediatrics 1
Good hygiene practices are essential to prevent spread, including not sharing equipment or water bottles, as recommended by the American Academy of Pediatrics 2
Good hygiene practices are essential to prevent spread, including limiting exposure to infected people and contaminated surfaces, according to the American Academy of Pediatrics 2
Good hygiene practices are essential to prevent spread, including prompt identification and proper treatment of infected individuals, as stated by the American Academy of Pediatrics 2

Local health department regulations may have additional requirements for return to school or sports, as noted by the British Association of Dermatologists 4