Impetigo medical therapy: Difference between revisions

Jump to navigation Jump to search
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 near the oral cavity or the scalp





Revision as of 18:47, 18 April 2017

Impetigo Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Impetigo from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

X Ray

CT

MRI

Ultrasound

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Impetigo medical therapy On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Impetigo medical therapy

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Impetigo medical therapy

CDC on Impetigo medical therapy

Impetigo medical therapy in the news

Blogs on Impetigo medical therapy

Directions to Hospitals Treating Impetigo

Risk calculators and risk factors for Impetigo medical therapy

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]
  • 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.[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 near the oral cavity or the scalp


▸ Click on the following categories to expand treatment regimens.

Bullous Impetigo

  ▸  Adults

  ▸  Children

Non-Bullous Impetigo

  ▸  Adults

  ▸  Children

Bullous Impetigo - Adults†
High suspicion for MRSA
Preferred Regimen
Vancomycin 15 mg/kg IV q12h
OR
Linezolid 600 mg PO q12h
OR
Clindamycin 300-450 mg PO q8h
Alternative Regimen
Doxycycline 100 mg PO q12h
OR
Minocycline 100 mg PO q12h
OR
TMP/SMZ 160/800 mg (1-2 tablets) PO q12h
† Adapted from Guidelines for Skin and Soft-Tissue Infections CID 2005[9]
Low suspicion for MRSA
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[9]
‡ Most S. aureus and Streptococci may be resistant against erythromycin
Bullous Impetigo - Children†
High suspicion for MRSA
Preferred Regimen
Vancomycin 10 mg/kg IV q6h
OR
Linezolid 10 mg/kg PO q12h
OR
Clindamycin 10-20 mg/kg/day PO divided in 3 doses
Alternative Regimen
TMP/SMZ‡ 8-12 mg/kg/day PO divided in 2 doses
† Adapted from Guidelines for Skin and Soft-Tissue Infections CID 2005[9]
‡ TMP/SMZ dose is based on the TMP component.
Low suspicion for MRSA
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[9]
‡ 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[9]
‡ 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[9]
‡ Most S. aureus and Streptococci may be resistant against erythromycin


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 (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
  • 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
  • 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 (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
  • 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

References

  1. 1.0 1.1 Rhody C (2000). "Bacterial infections of the skin". Prim Care. 27 (2): 459–73. PMID 10815055.
  2. Brown J, Shriner DL, Schwartz RA, Janniger CK (2003). "Impetigo: an update". Int J Dermatol. 42 (4): 251–5. PMID 12694487.
  3. Cole C, Gazewood J (2007). "Diagnosis and treatment of impetigo". Am Fam Physician. 75 (6): 859–64. PMID 17390597.
  4. 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.
  5. 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.
  6. 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)
  7. 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)
  8. Pereira LB (2014). "Impetigo - review". An Bras Dermatol. 89 (2): 293–9. PMC 4008061. PMID 24770507.
  9. 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.
  10. 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.
  11. 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.

Template:WH Template:WS