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Treatment
Impetigo and Ecthyma
Î Gram stain and culture of the pus or exudates from skin lesions of
impetigo and ecthyma are recommended to help identify whether
Staphylococcus aureus and/or a β-hemolytic streptococcus is the
cause (SR-M), but treatment without these studies is reasonable in
typical cases (SR-M).
Î Bullous and nonbullous impetigo can be treated with oral or topical
antimicrobials, but oral therapy is recommended for patients with
numerous lesions or in outbreaks affecting several people to help
decrease transmission of infection. Treatment for ecthyma should be
an oral antimicrobial.
• Treatment of bullous and nonbullous impetigo should be with either mupirocin or
retapamulin bid for 5 days (SR-H).
• Oral therapy for ecthyma or impetigo should be a 7-day regimen with an
agent active against S. aureus unless cultures yield streptococci alone (when
oral penicillin is the recommended agent) (SR-H). Because S. aureus isolates
from impetigo and ecthyma are usually methicillin-susceptible, dicloxacillin or
cephalexin is recommended. When MRSA is suspected or confirmed, doxycycline,
clindamycin, or sulfamethoxazole-trimethoprim (SMX-TMP) is recommended
(SR-M).
• Systemic antimicrobials should be used for infections during outbreaks of
post-streptococcal glomerulonephritis to help eliminate nephritogenic strains
of Streptococcus pyogenes from the community (SR-M)
