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__NOTOC__ | __NOTOC__ | ||
{{Impetigo}} | {{Impetigo}} | ||
{{CMG}} | {{CMG}}; {{AE}} {{USAMA}} | ||
==Overview== | ==Overview== | ||
The mainstay of therapy for impetigo is antimicrobial therapy. Topical therapy is preferred unless there is an indication for systemic therapy.<ref name="pmid10815055">{{cite journal| author=Rhody C| title=Bacterial infections of the skin. | journal=Prim Care | year= 2000 | volume= 27 | issue= 2 | pages= 459-73 | pmid=10815055 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10815055 }} </ref><ref name="pmid12694487">{{cite journal| author=Brown J, Shriner DL, Schwartz RA, Janniger CK| title=Impetigo: an update. | journal=Int J Dermatol | year= 2003 | volume= 42 | issue= 4 | pages= 251-5 | pmid=12694487 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12694487 }} </ref>Empiric therapy for mild disease includes either [[Mupirocin]] or [[Retapamulin]] applied topically. [[Empiric therapy]] for numerous lesions or poststreptococcoal glomerulonephritis includes either [[Dicloxacillin]], [[Amoxicillin-Clavulanate]], or [[Cephalexin]]. [[Penicillin]] is the drug of choice for impetigo caused by ''Streptococcus''. Patients with impetigo caused by ''[[Methicillin-resistant Staphylococcus aureus]]'' are treated with either [[Doxycycline]], [[Clindamycin]], or [[Sulfamethoxazole-Trimethoprim]]. Non-bullous impetigo is self resolving and usually takes 1-2 weeks.<ref name="pmid17390597">{{cite journal| author=Cole C, Gazewood J| title=Diagnosis and treatment of impetigo. | journal=Am Fam Physician | year= 2007 | volume= 75 | issue= 6 | pages= 859-64 | pmid=17390597 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17390597 }} </ref><ref name="pmid22258953">{{cite journal| author=Koning S, van der Sande R, Verhagen AP, van Suijlekom-Smit LW, Morris AD, Butler CC et al.| title=Interventions for impetigo. | journal=Cochrane Database Syst Rev | year= 2012 | volume= 1 | issue= | pages= CD003261 | pmid=22258953 | doi=10.1002/14651858.CD003261.pub3 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22258953 }} </ref> | |||
==Medical Therapy== | ==Medical Therapy== | ||
* Topical therapy is preferred for patients with small amount of lesions and without any bullae<ref>{{Cite journal | * [[Topical]] therapy is preferred for patients with small amount of [[lesions]] and without any bullae<ref name="pmid10815055">{{cite journal| author=Rhody C| title=Bacterial infections of the skin. | journal=Prim Care | year= 2000 | volume= 27 | issue= 2 | pages= 459-73 | pmid=10815055 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10815055 }} </ref><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]] | | 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 | | title = Interventions for impetigo | ||
| Line 17: | Line 17: | ||
| doi = 10.1002/14651858.CD003261.pub3 | | doi = 10.1002/14651858.CD003261.pub3 | ||
| pmid = 22258953 | | pmid = 22258953 | ||
}}</ref>; but oral therapy is also accepted.<ref>{{Cite journal | }}</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]] | | 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 | | title = Treatment of impetigo: oral antibiotics most commonly prescribed | ||
| Line 29: | Line 29: | ||
}}</ref> | }}</ref> | ||
* Oral regimens are used for patients with several lesions and patients with bullous [[impetigo]]. | * [[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. | * 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 | * [[Handwashing|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]] | | 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 | | title = Effect of handwashing on child health: a randomised controlled trial | ||
| Line 49: | Line 49: | ||
* The recommended duration of therapy is 7 days but will depend on the clinical response. | * The recommended duration of therapy is 7 days but will depend on the clinical response. | ||
*Indications for systemic therapy include:<ref name="pmid24770507">{{cite journal| author=Pereira LB| title=Impetigo - review. | journal=An Bras Dermatol | year= 2014 | volume= 89 | issue= 2 | pages= 293-9 | pmid=24770507 | doi= | pmc=4008061 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24770507 }} </ref> | |||
**Involvement of deeper layers | |||
**[[Pharyngitis]] | |||
**[[Lymphadenopathy]] | |||
**Widespread [[infection]] | |||
**[[Infection]] around the oral cavity or the scalp | |||
| Line 203: | Line 210: | ||
:*1.1 '''Empiric antimicrobial therapy (covering methicillin-susceptible Staphylococcus aureus and β-hemolytic streptococci)''' | :*1.1 '''Empiric antimicrobial therapy (covering methicillin-susceptible Staphylococcus aureus and β-hemolytic streptococci)''' | ||
::*1.1.1 '''Limited number of lesions''' | ::*1.1.1 '''Limited number of lesions''' | ||
:::* Preferred regimen: [[Mupirocin]] topically bid for 5 days | :::* Preferred regimen (1): [[Mupirocin]] topically bid for 5 days | ||
:::* Preferred regimen (2): [[Retapamulin]] topically bid for 5 days | |||
::*1.1.2 '''Numerous lesions or outbreaks of post streptococcal glomerulonephritis''' | ::*1.1.2 '''Numerous lesions or outbreaks of post streptococcal glomerulonephritis''' | ||
:::* Preferred regimen: [[Dicloxacillin]] 250 mg PO qid for 7 days | :::* Preferred regimen (1): [[Dicloxacillin]] 250 mg PO qid for 7 days | ||
:::* Alternative regimen (for penicillin-allergic patients) | |||
:::* Preferred regimen (2): [[Amoxicillin-Clavulanate]] 875/125 mg PO bid for 7 days | |||
:::* Preferred regimen (3): [[Cephalexin]] 250 mg PO qid for 7 days | |||
:::* Alternative regimen (1): (for penicillin-allergic patients) [[Doxycycline]] 100 mg PO bid for 7 days | |||
:::* Alternative regimen (2): (for penicillin-allergic patients) [[Clindamycin]] 300–400 mg PO qid for 7 days | |||
:::* Alternative regimen (3): (for penicillin-allergic patients) [[Sulfamethoxazole-Trimethoprim]] 1–2 double-strength tablets PO bid for 7 days | |||
:*1.2 '''Culture-directed antimicrobial therapy''' | :*1.2 '''Culture-directed antimicrobial therapy''' | ||
::*1.2.1 '''Streptococcus alone''' | ::*1.2.1 '''Streptococcus alone''' | ||
:::* Preferred regimen: [[Penicillin V]] 250–500 mg PO qid for 7 days | :::* Preferred regimen: [[Penicillin V]] 250–500 mg PO qid for 7 days | ||
:::* Alternative regimen (for penicillin-allergic patients) | :::* Alternative regimen (1): (for penicillin-allergic patients) [[Erythromycin]] 250 mg PO qid for 7 days | ||
:::* Alternative regimen (2): (for penicillin-allergic patients) [[Clindamycin]] 300–400 mg PO qid for 7 days | |||
::*1.2.2 '''Methicillin-resistant Staphylococcus aureus''' | ::*1.2.2 '''Methicillin-resistant Staphylococcus aureus''' | ||
:::* Preferred regimen: [[Doxycycline]] 100 mg PO bid for 7 days | :::* Preferred regimen (1): [[Doxycycline]] 100 mg PO bid for 7 days | ||
:::* Preferred regimen (2): [[Clindamycin]] 300–450 mg PO qid for 7 days | |||
:::* Preferred regimen (3): [[Sulfamethoxazole-Trimethoprim]] 1–2 double-strength tablets PO bid for 7 days | |||
*2. '''Impetigo, pediatric''' | *2. '''Impetigo, pediatric''' | ||
:*2.1 '''Empiric antimicrobial therapy (covering methicillin-susceptible Staphylococcus aureus and β-hemolytic streptococci)''' | :*2.1 '''Empiric antimicrobial therapy (covering methicillin-susceptible Staphylococcus aureus and β-hemolytic streptococci)''' | ||
::*2.1.1 '''Limited number of lesions''' | ::*2.1.1 '''Limited number of lesions''' | ||
:::* Preferred regimen: [[Mupirocin]] topically bid for 5 days | :::* Preferred regimen (1): [[Mupirocin]] topically bid for 5 days | ||
:::* Preferred regimen (2): [[Retapamulin]] topically bid for 5 days | |||
::*2.1.2 '''Numerous lesions or outbreaks of poststreptococcal glomerulonephritis''' | ::*2.1.2 '''Numerous lesions or outbreaks of poststreptococcal glomerulonephritis''' | ||
:::* Preferred regimen: [[Amoxicillin-Clavulanate]] 25 mg/kg/day of amoxicillin component PO bid for 7 days | :::* Preferred regimen (1): [[Amoxicillin-Clavulanate]] 25 mg/kg/day of amoxicillin component PO bid for 7 days | ||
:::* Alternative regimen (for penicillin-allergic patients) | |||
:::* Preferred regimen (2): [[Cephalexin]] 25–50 mg/kg/day PO tid–qid for 7 days | |||
:::* Alternative regimen (1): (for penicillin-allergic patients) [[Clindamycin]] 25–30 mg/kg/day PO tid for 7 days | |||
:::* Alternative regimen (2): (for penicillin-allergic patients) [[Sulfamethoxazole-Trimethoprim]] 8–12 mg/kg/day PO bid for 7 days | |||
:*2.2 '''Culture-directed antimicrobial therapy''' | :*2.2 '''Culture-directed antimicrobial therapy''' | ||
::*2.2.1 '''Streptococcus alone''' | ::*2.2.1 '''Streptococcus alone''' | ||
:::* Preferred regimen: [[Penicillin V]] 60,000–100,000 U/kg PO qid for 7 days | :::* Preferred regimen: [[Penicillin V]] 60,000–100,000 U/kg PO qid for 7 days | ||
:::* Alternative regimen (for penicillin-allergic patients) | :::* Alternative regimen (1): (for penicillin-allergic patients) [[Erythromycin]] 40 mg/kg/day PO tid–qid for 7 days | ||
:::* Alternative regimen (2): (for penicillin-allergic patients) [[Clindamycin]] 20 mg/kg/day PO tid for 7 days | |||
::*2.2.2 '''Methicillin-resistant Staphylococcus aureus''' | ::*2.2.2 '''Methicillin-resistant Staphylococcus aureus''' | ||
:::* Preferred regimen: [[Clindamycin]] 25–30 mg/kg/day PO tid for 7 days | :::* Preferred regimen (1): [[Clindamycin]] 25–30 mg/kg/day PO tid for 7 days | ||
:::* Preferred regimen (2): [[Sulfamethoxazole-Trimethoprim]] 8–12 mg/kg/day PO bid for 7 days | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
{{WH}} | |||
{{WS}} | |||
[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Bacterial diseases]] | [[Category:Bacterial diseases]] | ||
[[Category:Infectious skin diseases]] | [[Category:Infectious skin diseases]] | ||
[[Category:Dermatology]] | [[Category:Dermatology]] | ||
[[Category:Infectious Disease Project]] | [[Category:Infectious Disease Project]] | ||
[[Category:Emergency mdicine]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Infectious disease]] | |||
[[Category:Gynecology]] | |||
[[Category:Urology]] | |||
Latest revision as of 22:21, 29 July 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Usama Talib, BSc, MD [2]
Overview
The mainstay of therapy for impetigo is antimicrobial therapy. Topical therapy is preferred unless there is an indication for systemic therapy.[1][2]Empiric therapy for mild disease includes either Mupirocin or Retapamulin applied topically. Empiric therapy for numerous lesions or poststreptococcoal glomerulonephritis includes either Dicloxacillin, Amoxicillin-Clavulanate, or Cephalexin. Penicillin is the drug of choice for impetigo caused by Streptococcus. Patients with impetigo caused by Methicillin-resistant Staphylococcus aureus are treated with either Doxycycline, Clindamycin, or Sulfamethoxazole-Trimethoprim. Non-bullous impetigo is self resolving and usually takes 1-2 weeks.[3][4]
Medical Therapy
- Topical therapy is preferred for patients with small amount of lesions and without any bullae[1][5]; but oral therapy is also accepted.[6]
- 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.[7]
- 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.
- Indications for systemic therapy include:[8]
- Involvement of deeper layers
- Pharyngitis
- Lymphadenopathy
- Widespread infection
- Infection around the oral cavity or the scalp
▸ Click on the following categories to expand treatment regimens.
|
Bullous Impetigo ▸ Adults ▸ Children Non-Bullous Impetigo ▸ Adults ▸ Children |
|
Antimicrobial regimen
- 1.1 Empiric antimicrobial therapy (covering methicillin-susceptible Staphylococcus aureus and β-hemolytic streptococci)
- 1.1.1 Limited number of lesions
- Preferred regimen (1): Mupirocin topically bid for 5 days
- Preferred regimen (2): Retapamulin topically bid for 5 days
- 1.1.2 Numerous lesions or outbreaks of post streptococcal glomerulonephritis
- Preferred regimen (1): Dicloxacillin 250 mg PO qid for 7 days
- Preferred regimen (2): Amoxicillin-Clavulanate 875/125 mg PO bid for 7 days
- Preferred regimen (3): Cephalexin 250 mg PO qid for 7 days
- Alternative regimen (1): (for penicillin-allergic patients) Doxycycline 100 mg PO bid for 7 days
- Alternative regimen (2): (for penicillin-allergic patients) Clindamycin 300–400 mg PO qid for 7 days
- Alternative regimen (3): (for penicillin-allergic patients) Sulfamethoxazole-Trimethoprim 1–2 double-strength tablets PO bid for 7 days
- 1.2 Culture-directed antimicrobial therapy
- 1.2.1 Streptococcus alone
- Preferred regimen: Penicillin V 250–500 mg PO qid for 7 days
- Alternative regimen (1): (for penicillin-allergic patients) Erythromycin 250 mg PO qid for 7 days
- Alternative regimen (2): (for penicillin-allergic patients) Clindamycin 300–400 mg PO qid for 7 days
- 1.2.2 Methicillin-resistant Staphylococcus aureus
- Preferred regimen (1): Doxycycline 100 mg PO bid for 7 days
- Preferred regimen (2): Clindamycin 300–450 mg PO qid for 7 days
- Preferred regimen (3): Sulfamethoxazole-Trimethoprim 1–2 double-strength tablets PO bid for 7 days
- 2. Impetigo, pediatric
- 2.1 Empiric antimicrobial therapy (covering methicillin-susceptible Staphylococcus aureus and β-hemolytic streptococci)
- 2.1.1 Limited number of lesions
- Preferred regimen (1): Mupirocin topically bid for 5 days
- Preferred regimen (2): Retapamulin topically bid for 5 days
- 2.1.2 Numerous lesions or outbreaks of poststreptococcal glomerulonephritis
- Preferred regimen (1): Amoxicillin-Clavulanate 25 mg/kg/day of amoxicillin component PO bid for 7 days
- Preferred regimen (2): Cephalexin 25–50 mg/kg/day PO tid–qid for 7 days
- Alternative regimen (1): (for penicillin-allergic patients) Clindamycin 25–30 mg/kg/day PO tid for 7 days
- Alternative regimen (2): (for penicillin-allergic patients) Sulfamethoxazole-Trimethoprim 8–12 mg/kg/day PO bid for 7 days
- 2.2 Culture-directed antimicrobial therapy
- 2.2.1 Streptococcus alone
- Preferred regimen: Penicillin V 60,000–100,000 U/kg PO qid for 7 days
- Alternative regimen (1): (for penicillin-allergic patients) Erythromycin 40 mg/kg/day PO tid–qid for 7 days
- Alternative regimen (2): (for penicillin-allergic patients) Clindamycin 20 mg/kg/day PO tid for 7 days
- 2.2.2 Methicillin-resistant Staphylococcus aureus
- Preferred regimen (1): Clindamycin 25–30 mg/kg/day PO tid for 7 days
- Preferred regimen (2): Sulfamethoxazole-Trimethoprim 8–12 mg/kg/day PO bid for 7 days
References
- ↑ 1.0 1.1 Rhody C (2000). "Bacterial infections of the skin". Prim Care. 27 (2): 459–73. PMID 10815055.
- ↑ Brown J, Shriner DL, Schwartz RA, Janniger CK (2003). "Impetigo: an update". Int J Dermatol. 42 (4): 251–5. PMID 12694487.
- ↑ Cole C, Gazewood J (2007). "Diagnosis and treatment of impetigo". Am Fam Physician. 75 (6): 859–64. PMID 17390597.
- ↑ Koning S, van der Sande R, Verhagen AP, van Suijlekom-Smit LW, Morris AD, Butler CC; et al. (2012). "Interventions for impetigo". Cochrane Database Syst Rev. 1: CD003261. doi:10.1002/14651858.CD003261.pub3. PMID 22258953.
- ↑ 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.
- ↑ 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) - ↑ 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) - ↑ Pereira LB (2014). "Impetigo - review". An Bras Dermatol. 89 (2): 293–9. PMC 4008061. PMID 24770507.
- ↑ 9.0 9.1 9.2 9.3 9.4 9.5 Stevens DL, Bisno AL, Chambers HF, Everett ED, Dellinger P, Goldstein EJ; et al. (2005). "Practice guidelines for the diagnosis and management of skin and soft-tissue infections". Clin Infect Dis. 41 (10): 1373–406. doi:10.1086/497143. PMID 16231249.
- ↑ Liu C, Bayer A, Cosgrove SE, Daum RS, Fridkin SK, Gorwitz RJ; et al. (2011). "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. 52 (3): e18–55. doi:10.1093/cid/ciq146. PMID 21208910.
- ↑ Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL; et al. (2014). "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. 59 (2): 147–59. doi:10.1093/cid/ciu296. PMID 24947530.