Treatment of Impetigo

Introduction to Impetigo Treatment

The American College of Physicians recommends topical mupirocin as the first-line treatment for localized impetigo, while oral antibiotics are recommended for extensive disease or when topical therapy is impractical 1
Lesions typically occur on exposed areas of the body, particularly face and extremities 2

Topical therapy is preferred for limited disease due to fewer systemic side effects 3
Mupirocin 2% ointment applied three times daily for 5-7 days is the preferred topical treatment 1
Oral antibiotics should be used when impetigo is extensive or involves multiple sites 1
Oral antibiotics should be used when topical therapy is impractical 3
Dicloxacillin: 250 mg four times daily for adults is recommended for presumed methicillin-susceptible S. aureus (MSSA) 1, 3
Cephalexin: 250-500 mg four times daily for adults is recommended for presumed methicillin-susceptible S. aureus (MSSA) 1, 3
Clindamycin: 300-450 mg three times daily for adults is recommended for suspected or confirmed MRSA 1, 3

Penicillin alone is not effective for impetigo as it lacks adequate coverage against S. aureus 1, 3
Duration of therapy: 5-7 days for topical treatment and 5-10 days for oral antibiotics 1
Obtain cultures from lesions if there is treatment failure, MRSA is suspected, or in cases of recurrent infections 1
Keep lesions covered with clean, dry bandages and maintain good personal hygiene to prevent spread 1

For pregnant patients, cephalexin is generally considered safe 1, 3
Avoid tetracyclines (doxycycline, minocycline) in children under 8 years and pregnant women 1, 3
For pediatric patients, dosing should be adjusted appropriately, such as dicloxacillin: 12 mg/kg/day in 4 divided doses 3

Re-evaluate if no improvement after 48-72 hours of therapy 3
Consider alternative diagnosis if presentation is atypical or not responding to appropriate therapy 3