Information from references 6 , 8 , 11 , 14 , and 17 through Retapamulin is a novel pleuromutilin antibacterial and the first new topical antibacterial in nearly 20 years. In , the U. Retapamulin is not approved for intranasal staphylococcal carrier treatment or treatment of MRSA-related skin infections. Mupirocin is available as a less expensive generic version and as a brand.
All available mupirocin products are less expensive than the newer brand-only retapamulin ointment Table 2 6 , 8 , 11 , 14 , 17 — Oral antibiotic therapy can be used for impetigo with large bullae or when topical therapy is impractical Table 3.
There is no clear evidence-based preference among the different classes of oral antibiotics. Comparison studies also show no significant difference in cure rates between topical and oral antibiotics. No macrolide was found to be better than another, but all were found superior to penicillin V potassium; however, because of increasing macrolide resistance, they are no longer a preferred option. Although cephalosporins may be used, there is no evidence that one generation is better than another.
Younger than three months: 30 mg per kg per day. Loading dose of 4 mg per kg for first dose maximum dose of mg , then 4 mg per kg per day in divided doses every 12 hours. There is no activity against streptococcus. Information from references 12 and The incidence of MRSA-related skin and soft tissue infections was increasing, but more recent studies show it may be declining. Oral clindamycin penetrates skin and skin structures and should be considered if MRSA infection is suspected.
Because of an increasing risk of pseudomembranous colitis, clindamycin should be reserved for patients allergic to penicillin, or for infections that fail to respond to other treatments. Tetracyclines can be used for susceptible MRSA infections, but should be avoided in children younger than eight years.
There are some studies on the benefits of nonantibiotic treatments, such as disinfectant soaps, but they lack statistical power. The evidence is insufficient to recommend or dismiss popular herbal treatments for impetigo. Future treatments for impetigo might include minocycline foam Foamix , which has successfully completed phase II trials, and Ozenoxacin, a topical quinolone that has successfully completed phase III clinical trials.
This area seems to merit further study through rigorous clinical trials. Data Sources : A PubMed search was conducted for impetigo-related topics, including clinical reviews, randomized controlled trials, and meta-analyses. Search terms included impetigo; impetigo and treatment; retapamulin; fusidic acid; impetigo and MRSA; natural and herbal treatments for impetigo; minocycline foam Foamix ; Ozenoxacin; antibiotic resistance and impetigo; and topical and systemic treatments for impetigo.
Search dates: April to December , and May Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. Byrd Health Sciences Center in Morgantown. Byrd Health Sciences Center. Byrd Health Sciences Center, P. Box , Morgantown, WV e-mail: hhartman hsc. Reprints are not available from the authors. Impetigo: an update. Int J Dermatol. Feaster T, Singer JI. Topical therapies for impetigo. Pediatr Emerg Care.
Staphylococcus aureus -associated skin and soft tissue infections in ambulatory care. Emerg Infect Dis. Cole C, Gazewood J. Skin and soft tissue infections in returning travelers. Am J Trop Med Hyg. Bacterial resistance and impetigo treatment trends: a review.
Pediatr Dermatol. Effect of handwashing on child health: a randomised controlled trial. Interventions for impetigo. Cochrane Database Syst Rev. Staphylococcal exfoliative toxin B specifically cleaves desmoglein 1. J Invest Dermatol. Hsu S, Halmi BH. Bockhart's impetigo: complication of waterbed use. George A, Rubin G.
A systematic review and meta-analysis of treatments for impetigo. Br J Gen Pract. Silverberg N, Block S. Uncomplicated skin and skin structure infections in children: diagnosis and current treatment options in the United States. Clin Pediatr Phila. Ilyas M, Tolaymat A. Changing epidemiology of acute post-streptococcal glomerulonephritis in Northeast Florida: a comparative study. Pediatr Nephrol. Retapamulin: an antibacterial with a novel mode of action in an age of emerging resistance to Staphylococcus aureus.
J Drugs Dermatol. Practice guidelines for the diagnosis and management of skin and soft-tissue infections [published corrections appear in Clin Infect Dis.
Clin Infect Dis. Streptococcal infections of skin and soft tissues. N Engl J Med. Impetigo is very infectious.
Check with the GP before you go into the surgery. They may suggest a phone consultation. A GP will check it's not something more serious, like cellulitis. If it's impetigo, they can prescribe antibiotic cream to speed up your recovery or antibiotic tablets if it's very bad. A GP can take a swab from around your nose to check for the bacteria that causes impetigo. They might prescribe an antiseptic nasal cream to try to clear the bacteria and stop the impetigo coming back.
Do not stop using the antibiotic cream or tablets early, even if the impetigo starts to clear up. Ecthyma Open pop-up dialog box Close.
Ecthyma A more serious form of impetigo, called ecthyma, penetrates deeper into the skin — causing painful fluid- or pus-filled sores that turn into deep ulcers. Request an Appointment at Mayo Clinic. Share on: Facebook Twitter. Show references AskMayoExpert. Mayo Clinic; Baddour LM. Accessed Jan. Ferri FF, et al. Diseases and disorders. Elsevier; Kliegman RM, et al. Cutaneous bacterial infections. In: Nelson Textbook of Pediatrics.
Cherry JD, et al. Skin infections. Taylor SC. Bullous and pustular disorders. In: Treatments for Skin of Color. Office of Patient Education.
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