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==Overview==
==Overview==
Topical or oral [[antibiotic]]s are usually prescribed.
* The treatment of [[impetigo]] depends on the location, number of lesions and the type (bullous or non-bullous). Antibiotic therapy could be administered topically or orally.


==Medical Therapy==
==Medical Therapy==
Treatment may involve washing with soap and water and letting the impetigo dry in the air.
* Topical therapy is preferred for patients with small amount of lesions and without any bullae<ref>{{Cite journal
| author = [[Sander Koning]], [[Renske van der Sande]], [[Arianne P. Verhagen]], [[Lisette W. A. van Suijlekom-Smit]], [[Andrew D. Morris]], [[Christopher C. Butler]], [[Marjolein Berger]] & [[Johannes C. van der Wouden]]
| title = Interventions for impetigo
| journal = [[The Cochrane database of systematic reviews]]
| volume = 1
| pages = CD003261
| year = 2012
| month =
| doi = 10.1002/14651858.CD003261.pub3
| pmid = 22258953
}}</ref>; but oral therapy is also accepted.<ref>{{Cite journal
| author = [[Ranti S. Bolaji]], [[Tushar S. Dabade]], [[Cheryl J. Gustafson]], [[Scott A. Davis]], [[Daniel P. Krowchuk]] & [[Steven R. Feldman]]
| title = Treatment of impetigo: oral antibiotics most commonly prescribed
| journal = [[Journal of drugs in dermatology : JDD]]
| volume = 11
| issue = 4
| pages = 489–494
| year = 2012
| month = April
| pmid = 22453587
}}</ref>


Many general practitioners choose to treat impetigo with bactericidal ointment, such as [[fusidic acid]] (Fucidin) or [[mupirocin]] (Bactroban), but in more severe cases oral antibiotics, such as [[flucloxacillin]] (e.g. Floxapen) or [[erythromycin]] (e.g. Erythrocin) or [[Dicloxacillin]] are necessary.
* Oral regimens are used for patients with several lesions and patients with bullous [[impetigo]].
 
* Non-medical therapy involves washing the lesions and the rest of the body with soap and water, and letting the impetigo dry in the air.
 
* Hand-washing and daily bathing is considered a method to prevent impetigo in children.<ref>{{Cite journal
| author = [[Stephen P. Luby]], [[Mubina Agboatwalla]], [[Daniel R. Feikin]], [[John Painter]], [[Ward Billhimer]], [[Arshad Altaf]] & [[Robert M. Hoekstra]]
| title = Effect of handwashing on child health: a randomised controlled trial
| journal = [[Lancet]]
| volume = 366
| issue = 9481
| pages = 225–233
| year = 2005
| month = July
| doi = 10.1016/S0140-6736(05)66912-7
| pmid = 16023513
}}</ref>
 
* It is very important to remove the crusts before applying ointment, as the [[bacteria]] that cause the disease are located underneath them.
 
* The recommended duration of therapy is 7 days but will depend on the clinical response.
 
 
<SMALL><font color="#FF4C4C">'''▸ Click on the following categories to expand treatment regimens.'''</font></SMALL>
 
{|
| valign=top |
<div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #A1BCDD; text-align: center;">
<font color="#FFF">
'''Bullous Impetigo'''
</font>
</div>
 
<div class="mw-customtoggle-table01" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Adults'''
</font>
</div>
 
<div class="mw-customtoggle-table02" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Children'''
</font>
</div>
 
<div style="border-radius: 0 0 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #A1BCDD; text-align: center;">
<font color="#FFF">
'''Non-Bullous Impetigo'''
</font>
</div>
 
<div class="mw-customtoggle-table03" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Adults'''
</font>
</div>
 
<div class="mw-customtoggle-table04" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Children'''
</font>
</div>
 
| valign=top |
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table01" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Bullous Impetigo - Adults†}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Dicloxacillin]] 250 mg PO q6h''''' <br> OR <br> ▸ '''''[[Cephalexin]] 250 mg PO q6h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left |▸ '''''[[Erythromycin]]‡ 250 mg PO q6h'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | <small>† Adapted from Guidelines for Skin and Soft-Tissue Infections CID 2005<ref>{{Cite journal
| author = [[Dennis L. Stevens]], [[Alan L. Bisno]], [[Henry F. Chambers]], [[E. Dale Everett]], [[Patchen Dellinger]], [[Ellie J. C. Goldstein]], [[Sherwood L. Gorbach]], [[Jan V. Hirschmann]], [[Edward L. Kaplan]], [[Jose G. Montoya]] & [[James C. Wade]]
| title = Practice guidelines for the diagnosis and management of skin and soft-tissue infections
| journal = [[Clinical infectious diseases : an official publication of the Infectious Diseases Society of America]]
| volume = 41
| issue = 10
| pages = 1373–1406
| year = 2005
| month = November
| doi = 10.1086/497143
| pmid = 16231249
}}</ref> <br> ‡ Most S. aureus and Streptococci may be resistant against erythromycin</small>
|-
|}
|}
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table02" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Bullous Impetigo - Children†}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Dicloxacillin]] 12 mg/kg/day PO divided q6h''''' <br> OR <br> ▸ '''''[[Cephalexin]] 25 mg /kg/day PO divided q6h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left |▸ '''''[[Erythromycin]]‡ 40 mg/ kg/day divided PO q6h'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | <small>† Adapted from Guidelines for Skin and Soft-Tissue Infections CID 2005<ref>{{Cite journal
| author = [[Dennis L. Stevens]], [[Alan L. Bisno]], [[Henry F. Chambers]], [[E. Dale Everett]], [[Patchen Dellinger]], [[Ellie J. C. Goldstein]], [[Sherwood L. Gorbach]], [[Jan V. Hirschmann]], [[Edward L. Kaplan]], [[Jose G. Montoya]] & [[James C. Wade]]
| title = Practice guidelines for the diagnosis and management of skin and soft-tissue infections
| journal = [[Clinical infectious diseases : an official publication of the Infectious Diseases Society of America]]
| volume = 41
| issue = 10
| pages = 1373–1406
| year = 2005
| month = November
| doi = 10.1086/497143
| pmid = 16231249
}}</ref> <br> ‡ Most S. aureus and Streptococci may be resistant against erythromycin</small>
|-
|}
|}
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table03" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Non-Bullous Impetigo - Adults}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Topical Regimen
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Mupirocin]] 2% apply to lesions q8h x 7 days''''' <br> OR <br> ▸'''''[[Fusidic acid]] 2% apply to lesions q8h x 7 days''''' <br> OR <br> ▸ '''''[[Retapamulin]] 1% apply to lesions q12h x 5 days'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Oral Regimen
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Dicloxacillin]] 250 mg PO q6h''''' <br> OR <br> ▸ '''''[[Cephalexin]] 250 mg PO q6h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Oral Regimen
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left |▸ '''''[[Erythromycin]]‡ 250 mg PO q6h'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | <small>† Adapted from Guidelines for Skin and Soft-Tissue Infections CID 2005<ref>{{Cite journal
| author = [[Dennis L. Stevens]], [[Alan L. Bisno]], [[Henry F. Chambers]], [[E. Dale Everett]], [[Patchen Dellinger]], [[Ellie J. C. Goldstein]], [[Sherwood L. Gorbach]], [[Jan V. Hirschmann]], [[Edward L. Kaplan]], [[Jose G. Montoya]] & [[James C. Wade]]
| title = Practice guidelines for the diagnosis and management of skin and soft-tissue infections
| journal = [[Clinical infectious diseases : an official publication of the Infectious Diseases Society of America]]
| volume = 41
| issue = 10
| pages = 1373–1406
| year = 2005
| month = November
| doi = 10.1086/497143
| pmid = 16231249
}}</ref> <br> ‡ Most S. aureus and Streptococci may be resistant against erythromycin</small>
|-
|}
|}
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table04" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Non-Bullous Impetigo - Children†}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Topical Regimen
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Mupirocin]] 2% apply to lesions q8h x 7 days''''' <br> OR <br> ▸'''''[[Fusidic acid]] 2% apply to lesions q8h x 7 days''''' <br> OR <br> ▸ '''''[[Retapamulin]] 1% apply to lesions q12h x 5 days'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Oral Regimen
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Dicloxacillin]] 12 mg/kg/day PO divided q6h''''' <br> OR <br> ▸ '''''[[Cephalexin]] 25 mg /kg/day PO divided q6h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Oral Regimen
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left |▸ '''''[[Erythromycin]]‡ 40 mg/ kg/day divided PO q6h'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | <small>† Adapted from Guidelines for Skin and Soft-Tissue Infections CID 2005<ref>{{Cite journal
| author = [[Dennis L. Stevens]], [[Alan L. Bisno]], [[Henry F. Chambers]], [[E. Dale Everett]], [[Patchen Dellinger]], [[Ellie J. C. Goldstein]], [[Sherwood L. Gorbach]], [[Jan V. Hirschmann]], [[Edward L. Kaplan]], [[Jose G. Montoya]] & [[James C. Wade]]
| title = Practice guidelines for the diagnosis and management of skin and soft-tissue infections
| journal = [[Clinical infectious diseases : an official publication of the Infectious Diseases Society of America]]
| volume = 41
| issue = 10
| pages = 1373–1406
| year = 2005
| month = November
| doi = 10.1086/497143
| pmid = 16231249
}}</ref> <br> ‡ Most S. aureus and Streptococci may be resistant against erythromycin</small>
|-
|}
|}
|}


It is very important to remove the crusts before applying ointment, because the [[bacteria]] that cause the disease live underneath them.


==References==
==References==

Revision as of 20:49, 29 May 2014

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

  • The treatment of impetigo depends on the location, number of lesions and the type (bullous or non-bullous). Antibiotic therapy could be administered topically or orally.

Medical Therapy

  • Topical therapy is preferred for patients with small amount of lesions and without any bullae[1]; but oral therapy is also accepted.[2]
  • Oral regimens are used for patients with several lesions and patients with bullous impetigo.
  • Non-medical therapy involves washing the lesions and the rest of the body with soap and water, and letting the impetigo dry in the air.
  • Hand-washing and daily bathing is considered a method to prevent impetigo in children.[3]
  • It is very important to remove the crusts before applying ointment, as the bacteria that cause the disease are located underneath them.
  • The recommended duration of therapy is 7 days but will depend on the clinical response.


▸ Click on the following categories to expand treatment regimens.

Bullous Impetigo

  ▸  Adults

  ▸  Children

Non-Bullous Impetigo

  ▸  Adults

  ▸  Children

Bullous Impetigo - Adults†
Preferred Regimen
▸ Dicloxacillin 250 mg PO q6h
OR
▸ Cephalexin 250 mg PO q6h
Alternative Regimen
▸ Erythromycin‡ 250 mg PO q6h
† Adapted from Guidelines for Skin and Soft-Tissue Infections CID 2005[4]
‡ Most S. aureus and Streptococci may be resistant against erythromycin
Bullous Impetigo - Children†
Preferred Regimen
▸ Dicloxacillin 12 mg/kg/day PO divided q6h
OR
▸ Cephalexin 25 mg /kg/day PO divided q6h
Alternative Regimen
▸ Erythromycin‡ 40 mg/ kg/day divided PO q6h
† Adapted from Guidelines for Skin and Soft-Tissue Infections CID 2005[5]
‡ Most S. aureus and Streptococci may be resistant against erythromycin
Non-Bullous Impetigo - Adults
Topical Regimen
▸ Mupirocin 2% apply to lesions q8h x 7 days
OR
▸Fusidic acid 2% apply to lesions q8h x 7 days
OR
▸ Retapamulin 1% apply to lesions q12h x 5 days
Preferred Oral Regimen
▸ Dicloxacillin 250 mg PO q6h
OR
▸ Cephalexin 250 mg PO q6h
Alternative Oral Regimen
▸ Erythromycin‡ 250 mg PO q6h
† Adapted from Guidelines for Skin and Soft-Tissue Infections CID 2005[6]
‡ Most S. aureus and Streptococci may be resistant against erythromycin
Non-Bullous Impetigo - Children†
Topical Regimen
▸ Mupirocin 2% apply to lesions q8h x 7 days
OR
▸Fusidic acid 2% apply to lesions q8h x 7 days
OR
▸ Retapamulin 1% apply to lesions q12h x 5 days
Preferred Oral Regimen
▸ Dicloxacillin 12 mg/kg/day PO divided q6h
OR
▸ Cephalexin 25 mg /kg/day PO divided q6h
Alternative Oral Regimen
▸ Erythromycin‡ 40 mg/ kg/day divided PO q6h
† Adapted from Guidelines for Skin and Soft-Tissue Infections CID 2005[7]
‡ Most S. aureus and Streptococci may be resistant against erythromycin


References

  1. ↑ Sander Koning, Renske van der Sande, Arianne P. Verhagen, Lisette W. A. van Suijlekom-Smit, Andrew D. Morris, Christopher C. Butler, Marjolein Berger & Johannes C. van der Wouden (2012). "Interventions for impetigo". The Cochrane database of systematic reviews. 1: CD003261. doi:10.1002/14651858.CD003261.pub3. PMID 22258953.
  2. ↑ Ranti S. Bolaji, Tushar S. Dabade, Cheryl J. Gustafson, Scott A. Davis, Daniel P. Krowchuk & Steven R. Feldman (2012). "Treatment of impetigo: oral antibiotics most commonly prescribed". Journal of drugs in dermatology : JDD. 11 (4): 489–494. PMID 22453587. Unknown parameter |month= ignored (help)
  3. ↑ Stephen P. Luby, Mubina Agboatwalla, Daniel R. Feikin, John Painter, Ward Billhimer, Arshad Altaf & Robert M. Hoekstra (2005). "Effect of handwashing on child health: a randomised controlled trial". Lancet. 366 (9481): 225–233. doi:10.1016/S0140-6736(05)66912-7. PMID 16023513. Unknown parameter |month= ignored (help)
  4. ↑ Dennis L. Stevens, Alan L. Bisno, Henry F. Chambers, E. Dale Everett, Patchen Dellinger, Ellie J. C. Goldstein, Sherwood L. Gorbach, Jan V. Hirschmann, Edward L. Kaplan, Jose G. Montoya & James C. Wade (2005). "Practice guidelines for the diagnosis and management of skin and soft-tissue infections". Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 41 (10): 1373–1406. doi:10.1086/497143. PMID 16231249. Unknown parameter |month= ignored (help)
  5. ↑ Dennis L. Stevens, Alan L. Bisno, Henry F. Chambers, E. Dale Everett, Patchen Dellinger, Ellie J. C. Goldstein, Sherwood L. Gorbach, Jan V. Hirschmann, Edward L. Kaplan, Jose G. Montoya & James C. Wade (2005). "Practice guidelines for the diagnosis and management of skin and soft-tissue infections". Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 41 (10): 1373–1406. doi:10.1086/497143. PMID 16231249. Unknown parameter |month= ignored (help)
  6. ↑ Dennis L. Stevens, Alan L. Bisno, Henry F. Chambers, E. Dale Everett, Patchen Dellinger, Ellie J. C. Goldstein, Sherwood L. Gorbach, Jan V. Hirschmann, Edward L. Kaplan, Jose G. Montoya & James C. Wade (2005). "Practice guidelines for the diagnosis and management of skin and soft-tissue infections". Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 41 (10): 1373–1406. doi:10.1086/497143. PMID 16231249. Unknown parameter |month= ignored (help)
  7. ↑ Dennis L. Stevens, Alan L. Bisno, Henry F. Chambers, E. Dale Everett, Patchen Dellinger, Ellie J. C. Goldstein, Sherwood L. Gorbach, Jan V. Hirschmann, Edward L. Kaplan, Jose G. Montoya & James C. Wade (2005). "Practice guidelines for the diagnosis and management of skin and soft-tissue infections". Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 41 (10): 1373–1406. doi:10.1086/497143. PMID 16231249. Unknown parameter |month= ignored (help)

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