Impetigo Empiric Therapy
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Empiric therapeutic regimens for impetigo are outlined below, including those for localized, uncomplicated impetigo and those for widespread, or complicated, impetigo.
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 Staphylococcus aureus.
Topical therapy is preferred for localized, uncomplicated nonbullous or bullous impetigo. [1] Systemic antibiotics are used for widespread infections, complicated infections, outbreaks of poststreptococcal glomerulonephritis, or 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] As S aureus isolates from impetigo are usually methicillin-susceptible, cephalexin, amoxicillin-clavulanate, or dicloxacillin is usually recommended. Trimethoprim-sulfamethoxazole, clindamycin, or doxycycline is recommended for confirmed or highly suspected MRSA impetigo.
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]
Localized, uncomplicated impetigo
Localized, uncomplicated impetigo is treated as follows:
Widespread (complicated) impetigo [3, 4, 2, 5]
Widespread (complicated) impetigo is treated as follows:
Widespread (complicated) impetigo with confirmed MRSA [2]
Widespread (complicated) impetigo with confirmed MRSA is treated as follows:
Koning S, van der Sande R, Verhagen AP, van Suijlekom-Smit LW, Morris AD, Butler CC, et al. Interventions for impetigo. Cochrane Database Syst Rev. 2012 Jan 18. 1:CD003261. [Medline].
[Guideline] Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of america. Clin Infect Dis. 2014 Jul 15. 59(2):e10-52. [Medline].
[Guideline] Liu C, Bayer A, Cosgrove SE, Daum RS, Fridkin SK, Gorwitz RJ, et al. Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis. 2011 Feb 1. 52 (3):e18-55. [Medline].
Geria AN, Schwartz RA. Impetigo update: new challenges in the era of methicillin resistance. Cutis. 2010 Feb. 85(2):65-70. [Medline].
[Guideline] Liu C, Bayer A, Cosgrove SE, Daum RS, Fridkin SK, Gorwitz RJ, et al. Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children: executive summary. Clin Infect Dis. 2011 Feb 1. 52 (3):285-92. [Medline].
Lisa S Lewis, MD Attending Physician, Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center
Lisa S Lewis, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.
Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference
Disclosure: Received salary from Medscape for employment. for: Medscape.
Thomas E Herchline, MD Professor of Medicine, Wright State University, Boonshoft School of Medicine; Medical Consultant, Public Health, Dayton and Montgomery County (Ohio) Tuberculosis Clinic
Thomas E Herchline, MD is a member of the following medical societies: Alpha Omega Alpha, Infectious Diseases Society of America, Infectious Diseases Society of Ohio
Disclosure: Nothing to disclose.
Impetigo Empiric Therapy
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