Specific Organisms and Therapeutic Regimens
Organism-specific therapeutic regimens for impetigo are provided below, including those for group A beta-hemolytic Streptococcus, methicillin-susceptible Staphylococcus aureus (MSSA), and methicillin-resistant S aureus (MRSA).
Impetigo is a contagious, superficial bacterial infection commonly seen in children. Treatment typically involves local wound care along with topical or systemic antibiotic therapy with activity against beta-hemolytic streptococci and S aureus.
Topical therapy is preferred for localized, uncomplicated nonbullous or bullous impetigo. [1] Systemic antibiotics are used with widespread infections, complicated infections, outbreaks of poststreptococcal glomerulonephritis, multiple incidents that have occurred within the home, daycare, or athletic-team settings. The duration of therapy should be based on clinical improvement; however, a 7-day regimen is recommended. [2]
The Infectious Diseases Society of America (IDSA) published 2014 guidelines for the treatment of impetigo (see Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by the Infectious Diseases Society of America). [2]
Group A beta-hemolytic streptococcal impetigo
Localized, uncomplicated group A beta-hemolytic streptococcal impetigo is treated as follows:
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Mupirocin 2% cream/ointment applied topically BID for 5 days or
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Retapamulin 1% ointment applied topically BID for 5 days
Widespread, complicated group A beta-hemolytic streptococcal impetigo is treated as follows:
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Penicillin V 250-500 mg PO QID for 7 days or
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Amoxicillin 25-40 mg/kg/day divided BID for 7 days or
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Cephalexin 250 mg PO QID for 7 days in adults or 25 mg/kg/day in 4 divided doses for 7 days in children
MSSA impetigo
Localized, uncomplicated MSSA impetigo is treated as follows:
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Mupirocin 2% cream/ointment applied topically BID for 5 days or
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Retapamulin 1% ointment applied topically BID for 5 days
Widespread, complicated MSSA impetigo is treated as follows:
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Cephalexin 250 mg PO QID for 7 days in adults or 25 mg/kg/day in 4 divided doses for 7 days in children or
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Amoxicillin-clavulanate 875 mg/125 mg PO BID for 7 days in adults or 25 mg amoxicillin/kg/day PO divided BID for 7 days in children or
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Dicloxacillin 250 mg PO QID for 7 days in adults/children >40 kg or 25 mg/kg/day PO divided QID for 7 days in patients < 40 kg
Localized, uncomplicated MRSA impetigo is treated as follows:
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Mupirocin 2% cream/ointment applied topically BID for 5 days or
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Retapamulin 1% ointment applied topically BID for 5 days
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Ozenoxacin 1% cream applied topically BID for 5 days
Widespread, complicated MRSA impetigo is treated as follows:
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Trimethoprim-sulfamethoxazole TMP 160 mg PO BID for 7 days in adults or 8-12 mg TMP/kg/day PO divided BID for 7 days in children older than 2 months or
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Clindamycin 300 mg PO QID for 7 days in adults or 10-20 mg/kg/dose PO TID for 7 days in children or
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Doxycycline 100 mg PO BID for 7 days in patients >45 kg or 2 mg/kg/dose PO q12h for 7 days in patients < 45 kg and older than 8 years [3]