Impetigo

Skin infection affects children and adults. Bullous or non-bullous. Caused by Staph or Strep group A.

Diagnosis is clinical.

If impetigo is recurrent, evaluation for the carriage of the causative bacteria should be performed.  The nose is a common reservoir and carriers can be treated with mupirocin (Bactroban Nasal) applied in the nostrils. [1]

Impetigo is usually managed by an interprofessional team that consists of a nurse practitioner, primary care provider, pediatrician, and a dermatologist. Topical antibiotics alone or in conjunction with systemic antibiotics are used to treat impetigo. Antibiotic coverage should cover both S aureus and S pyogenes (i.e. GABHS). While untreated impetigo is often self-limiting, antibiotics decrease the duration of illness and spread of lesions. In addition, antibiotic treatment decreases the chances of complications involving kidneys, joints, bones, and lungs, as well as acute rheumatic fever.

The infectious disease should educate the patient to refrain from touching the skin lesions and the importance of handwashing. Because the infection is contagious, the school nurse should recommend that the child not return to daycare os school for at least 24-48 hours after starting antibiotic therapy.

In areas of a high prevalence of MRSA  or if cultures are positive for MRSA, clindamycin or doxycycline are the preferred treatments. Trimethoprim-sulfamethoxazole is effective against MRSA, but should only be used if group A streptococci are not the causative agent, or in addition to an anti-streptococcal antibiotic.[1]

For localized, uncomplicated, non-bullous impetigo, topical therapy alone is the treatment of choice.  The crust should be removed with soap and water before the application of topical antibiotic therapy. Mupirocin, retapamulin, and fusidic acid are the treatments of choice. [1]

Topical antibiotics are as effective as oral antibiotics in the treatment of impetigo. There is no evidence to support the combined use of a topical and an oral antibiotic for impetigo. Systemic antibiotics, such as cephalexin and doxycycline, are helpful in cases of widespread bullous impetigo or when methicillin-resistant S. aureus is suspected or confirmed. However, for localized nonbullous impetigo, topical antibiotics, such as mupirocin ointment, are effective. [2]