Source: Fish DN, Pendland SL, Danziger
LH. Skin and Soft-Tissue Infections. In: DiPiro, JT, Talbert RL, Yee
GC, Matzke GR, Wells BG, Posey LM. Pharmacotherapy: A Pathophysiologic
Approach. 8th ed. http://accesspharmacy.com/content.aspx?aid=8002378.
Accessed July 21, 2012.
- Superficial skin infection
- Staphylococcus aureus either
alone or in combination with S. pyogenes has
emerged as a principal cause of impetigo
- Bullous form caused by strains of S.
- Most cases caused by S. pyogenes.
- Minor trauma, such as scratches or insect bites, allows
organisms to enter superficial layers of skin.
- Most common in children
- Bullous form most frequently affects neonates.
- Highly communicable and spreads through close contact.
- Hot, humid weather facilitates microbial colonization of skin.
- Improved hygiene, especially handwashing
- Close contact at daycare centers and schools
- Face is most common site of infection
- Scratching of lesions may further
spread infection through excoriation of skin.
- Nonbullous impetigo
- Manifests initially as
small, fluid-filled vesicles.
- Rapidly develop into pus-filled blisters that readily rupture.
- Purulent discharge dries to form golden yellow crusts characteristic
- Bullous impetigo
- Weakness, fever, and diarrhea
may be seen.
- Lesions begin as vesicles.
- Turn into bullae containing clear yellow fluid.
soon rupture, forming thin, light brown crusts.
Means of Confirmation
- Complete blood counts (CBC): leukocytosis common.
- Culture purulent material at base of lesion.
- Rapid eradication of infection
- Symptom relief
- Prevent formation of new lesions.
- Prevent complications such as cellulitis.
- Soaking lesions with warm, soapy water provides symptomatic
relief and promotes removal of crusts on lesions.
- Penicillinase-resistant penicillins (e.g., dicloxacillin)
are agents of first choice because of increased isolation of S. aureus (Tables 1 and 2).
- Treat for 7–10 days.
Table 1. Evidence-Based
Recommendations for Treatment of Impetigo |Favorite Table|Download (.pdf)
Table 1. Evidence-Based
Recommendations for Treatment of Impetigo
|S. aureus accounts for majority
of infections; consequently, penicillin-resistant penicillin or
first-generation cephalosporin recommended.||A-I|
|Topical therapy with mupirocin equivalent to oral therapy.||A-I|
Table 2. Recommended Drugs
and Dosing Regimens for Outpatient Treatment of Mild to Moderate