Sandbox-ID-Skin and Soft Tissues

Skin and Soft Tissues

Impetigo ⇧ Return to Top ⇧

• Impetigo, bullous and nonbullous

• Causative pathogens

• Staphylococcus aureus
• Streptococcus, β-hemolytic

• Impetigo, adult

• Empiric antimicrobial therapy (covering methicillin-susceptible Staphylococcus aureus and β-hemolytic streptococci)

• Limited number of lesions

• Preferred regimen: Mupirocin topically bid for 5 days OR Retapamulin topically bid for 5 days

• Numerous lesions or outbreaks of poststreptococcal glomerulonephritis

• Preferred regimen: Dicloxacillin 250 mg PO qid for 7 days OR Amoxicillin-Clavulanate 875/125 mg PO bid for 7 days OR Cephalexin 250 mg PO qid for 7 days
• Alternative regimen (for penicillin-allergic patients): Doxycycline 100 mg PO bid for 7 days OR Clindamycin 300–400 mg PO qid for 7 days OR Sulfamethoxazole-Trimethoprim 1–2 double-strength tablets PO bid for 7 days

• Pathogen-directed antimicrobial therapy

• Streptococcus alone

• Preferred regimen: Penicillin V 250–500 mg PO qid for 7 days
• Alternative regimen (for penicillin-allergic patients): Erythromycin 250 mg PO qid for 7 days OR Clindamycin 300–400 mg PO qid for 7 days

• Staphylococcus aureus, methicillin-resistant (MRSA)

• Preferred regimen: Doxycycline 100 mg PO bid for 7 days OR Clindamycin 300–450 mg PO qid for 7 days OR Sulfamethoxazole-Trimethoprim 1–2 double-strength tablets PO bid for 7 days

• Impetigo, pediatric

• Empiric antimicrobial therapy (covering methicillin-susceptible Staphylococcus aureus and β-hemolytic streptococci)

• Limited number of lesions

• Preferred regimen: Mupirocin topically bid for 5 days OR Retapamulin topically bid for 5 days

• Numerous lesions or outbreaks of poststreptococcal glomerulonephritis

• Preferred regimen: Amoxicillin-Clavulanate 25 mg/kg/day of amoxicillin component PO bid for 7 days OR Cephalexin 25–50 mg/kg/day PO tid–qid for 7 days
• Alternative regimen (for penicillin-allergic patients): Clindamycin 25–30 mg/kg/day PO tid for 7 days OR Sulfamethoxazole-Trimethoprim 8–12 mg/kg/day PO bid for 7 days

• Pathogen-directed antimicrobial therapy

• Streptococcus alone

• Preferred regimen: Penicillin V 60,000–100,000 U/kg PO qid for 7 days
• Alternative regimen (for penicillin-allergic patients): Erythromycin 40 mg/kg/day PO tid–qid for 7 days OR Clindamycin 20 mg/kg/day PO tid for 7 days

• Staphylococcus aureus, methicillin-resistant (MRSA)

• Preferred regimen: Clindamycin 25–30 mg/kg/day PO tid for 7 days OR Sulfamethoxazole-Trimethoprim 8–12 mg/kg/day PO bid for 7 days