Impetigo

Undertake antibiotic treatment in neonates in collaboration with a pediatric dermatologist or infectious disease specialist.

Patients in the first month of life presenting with nonbullous impetigo require oral antibiotics.

Erythromycin is the initial choice. Treatment course is 7 days.

Intranasal antibiotics are generally not used in neonates.

In addition to the antibiotic treatment, twice-daily washing with soap and water is good general skin care for all patients with impetigo, as it helps reduce the amount of bacteria on the skin. This washing routine may also be recommended for close patient contacts who may have acquired the bacteria. Chlorhexidine is not recommended in neonates (due to issues related to its potential toxicity with absorption).

Undertake antibiotic treatment in neonates in collaboration with a pediatric dermatologist or infectious disease specialist.

Vancomycin is recommended if MRSA is suspected (cases of spontaneous abscess or cellulitis; lesions that do not resolve with recommended antibiotic treatment) and/or determined by antibiotic susceptibility testing. Treatment course is usually 7 to 10 days.

Intranasal antibiotics are generally not used in neonates.

In addition to the antibiotic treatment, twice-daily washing with soap and water is good general skin care for all patients with impetigo, as it helps reduce the amount of bacteria on the skin. This washing routine may also be recommended for close patient contacts who may have acquired the bacteria. Chlorhexidine is not recommended in neonates (due to issues related to its potential toxicity with absorption).

Undertake antibiotic treatment in neonates in collaboration with a pediatric dermatologist or infectious disease specialist.

If antibiotic susceptibility testing indicates MRSA, vancomycin is recommended. Treatment course is usually 7 to 10 days.

Intranasal antibiotics are generally not used in neonates.

In addition to the antibiotic treatment, twice-daily washing with soap and water is good general skin care for all patients with impetigo, as it helps reduce the amount of bacteria on the skin. This washing routine may also be recommended for close patient contacts who may have acquired the bacteria. Chlorhexidine is not recommended in neonates (due to issues related to its potential toxicity with absorption).

Undertake antibiotic treatment in neonates in collaboration with a pediatric dermatologist or infectious disease specialist.

Vancomycin is recommended if MRSA is suspected (cases of spontaneous abscess or cellulitis; lesions that do not resolve with recommended antibiotic treatment) and/or determined by antibiotic susceptibility testing. Treatment course is usually 7 to 10 days.

Intranasal antibiotics are generally not used in neonates.

In addition to the antibiotic treatment, twice-daily washing with soap and water is good general skin care for all patients with impetigo, as it helps reduce the amount of bacteria on the skin. This washing routine may also be recommended for close patient contacts who may have acquired the bacteria. Chlorhexidine is not recommended in neonates (due to issues related to its potential toxicity with absorption).

Treatment recommended for ALL patients in selected patient group

Intranasal antibiotic (applied to the nares at the same frequency as antibiotic skin application for 5 to 7 days of the month) is additionally used for patients who experience frequent recurrences of their impetigo.[36]The Primary Care Dermatology Society. Impetigo​. May 2022 [internet publication]. https://www.pcds.org.uk/clinical-guidance/impetigo ​ If several family members other than the patient are affected by impetigo, intranasal antibiotic alone would be prescribed for the unaffected individual(s). In either case, the intention is to decrease nasal colonization by bacteria. The nasal reservoir can serve as a source for reinfection of an individual or spread of the infection to close contacts.

These patients have no evidence of deeper soft tissue involvement (abscess, cellulitis) or hematogenous spread (fever, constitutional symptoms).

Oral antibiotics including dicloxacillin, erythromycin, or a first-generation cephalosporin (e.g., cephalexin) are the recommended agents for these patients. Treatment course is usually 7 days.

Immunocompromised patients are at greater risk for developing a complicated course of infection; parenteral antibiotic treatment is a consideration for patients with widespread lesions and severe immune compromise.[28]Koning S, van der Sande R, Verhagen AP, et al. Interventions for impetigo. Cochrane Database Syst Rev. 2012 Jan 18;(1):CD003261. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003261.pub3/full http://www.ncbi.nlm.nih.gov/pubmed/22258953?tool=bestpractice.com [30]Wallin TR, Hern HG, Frazee BW. Community-associated methicillin-resistant Staphylococcus aureus. Emerg Med Clin North Am. 2008 May;26(2):431-55. http://www.ncbi.nlm.nih.gov/pubmed/18406982?tool=bestpractice.com ​

In addition to topical antibiotic treatment, twice-daily washing with soap and water is good general skin care for all patients with impetigo, as it helps reduce the amount of bacteria on the skin. For older children and adults, particularly those with more widespread skin involvement, chlorhexidine can be a good antibacterial cleanser to add to the routine.[36]The Primary Care Dermatology Society. Impetigo​. May 2022 [internet publication]. https://www.pcds.org.uk/clinical-guidance/impetigo ​ Chlorhexidine is not recommended in young children (due to issues related to its potential toxicity with absorption). This washing routine may also be recommended for close patient contacts who may have acquired the bacteria.

Treatment recommended for SOME patients in selected patient group

Intranasal antibiotic (applied to the nares at the same frequency as antibiotic skin application for 5 to 7 days of the month) is additionally used for patients who experience frequent recurrences of their impetigo.[36]The Primary Care Dermatology Society. Impetigo​. May 2022 [internet publication]. https://www.pcds.org.uk/clinical-guidance/impetigo ​ If several family members other than the patient are affected by impetigo, intranasal antibiotic alone would be prescribed for the unaffected individual(s). In either case, the intention is to decrease nasal colonization by bacteria. The nasal reservoir can serve as a source for reinfection of an individual or spread of the infection to close contacts.

These patients have no evidence of deeper soft tissue involvement (abscess, cellulitis) or hematogenous spread (fever, constitutional symptoms).

If MRSA is suspected (cases of spontaneous abscess or cellulitis; lesions that do not resolve with recommended antibiotic treatment) and/or determined by antibiotic susceptibility testing, appropriate antibiotic choices include clindamycin, trimethoprim/sulfamethoxazole, or doxycycline. Treatment course is usually 7 days.

In addition to topical antibiotic treatment, twice-daily washing with soap and water is good general skin care for all patients with impetigo, as it helps reduce the amount of bacteria on the skin. For older children and adults, particularly those with more widespread skin involvement, chlorhexidine can be a good antibacterial cleanser to add to the routine.[36]The Primary Care Dermatology Society. Impetigo​. May 2022 [internet publication]. https://www.pcds.org.uk/clinical-guidance/impetigo ​ Chlorhexidine is not recommended in young children (due to issues related to its potential toxicity with absorption). This washing routine may also be recommended for close patient contacts who may have acquired the bacteria.

Treatment recommended for SOME patients in selected patient group

Intranasal antibiotic (applied to the nares at the same frequency as antibiotic skin application for 5 to 7 days of the month) is additionally used for patients who experience frequent recurrences of their impetigo. If several family members other than the patient are affected by impetigo, intranasal antibiotic alone would be prescribed for the unaffected individual(s). In either case, the intention is to decrease nasal colonization by bacteria. The nasal reservoir can serve as a source for reinfection of an individual or spread of the infection to close contacts.

Patients with evidence of soft tissue infection (abscess, cellulitis) or hematogenous spread (fever, constitutional symptoms) will require treatment with parenteral antibiotics.

Clindamycin, nafcillin, and oxacillin are all considered first-line options. Treatment course is usually 10 to 14 days. If the patient has positive blood cultures, reevaluate the status of blood cultures prior to discontinuation of parenteral treatment.

Collaboration with an infectious disease specialist (pediatric or adult) is a consideration when treating infants, children, immunocompromised patients, or any patient poorly responsive to initial parenteral antibiotic treatment.

In addition to the antibiotic treatment, twice-daily washing with soap and water is good general skin care for all patients with impetigo, as it helps reduce the amount of bacteria on the skin. For older children and adults, particularly those with more widespread skin involvement, chlorhexidine can be a good antibacterial cleanser to add to the routine.[36]The Primary Care Dermatology Society. Impetigo​. May 2022 [internet publication]. https://www.pcds.org.uk/clinical-guidance/impetigo ​ Chlorhexidine is not recommended in young children (due to issues related to its potential toxicity with absorption). This washing routine may also be recommended for close patient contacts who may have acquired the bacteria.

Treatment recommended for SOME patients in selected patient group

Intranasal antibiotic (applied to the nares at the same frequency as antibiotic skin application for 5 to 7 days of the month) is additionally used for patients who experience frequent recurrences of their impetigo. If several family members other than the patient are affected by impetigo, intranasal antibiotic alone would be prescribed for the unaffected individual(s). In either case, the intention is to decrease nasal colonization by bacteria. The nasal reservoir can serve as a source for reinfection of an individual or spread of the infection to close contacts.

Patients with evidence of soft tissue infection (abscess, cellulitis) or hematogenous spread (fever, constitutional symptoms) will require treatment with parenteral antibiotics.

Vancomycin is recommended if MRSA is suspected (cases of spontaneous abscess or cellulitis; lesions that do not resolve with recommended antibiotic treatment) and/or determined by antibiotic susceptibility testing. Treatment course is usually 10 to 14 days. If the patient has positive blood cultures, re-evaluate the status of blood cultures prior to discontinuation of parenteral treatment.

Collaboration with an infectious disease specialist (pediatric or adult) is a consideration for infants, children, immunocompromised patients, or any patient poorly responsive to initial parenteral antibiotic treatment.

When alternatives to vancomycin are required, oritavancin, dalbavancin, and tedizolid can be considered in patients with complicated impetigo who require parenteral therapy.

In addition to the antibiotic treatment, twice-daily washing with soap and water is good general skin care for all patients with impetigo, as it helps reduce the amount of bacteria on the skin. For older children and adults, particularly those with more widespread skin involvement, chlorhexidine can be a good antibacterial cleanser to add to the routine.[36]The Primary Care Dermatology Society. Impetigo​. May 2022 [internet publication]. https://www.pcds.org.uk/clinical-guidance/impetigo ​ Chlorhexidine is not recommended in young children (due to issues related to its potential toxicity with absorption). This washing routine may also be recommended for close patient contacts who may have acquired the bacteria.

Treatment recommended for SOME patients in selected patient group

Intranasal antibiotic (applied to the nares at the same frequency as antibiotic skin application for 5 to 7 days of the month) is additionally used for patients who experience frequent recurrences of their impetigo. If several family members other than the patient are affected by impetigo, intranasal antibiotic alone would be prescribed for the unaffected individual(s). In either case, the intention is to decrease nasal colonization by bacteria. The nasal reservoir can serve as a source for reinfection of an individual or spread of the infection to close contacts.