What are the causes and treatments for impetigo in adults?

Updated: Jun 14, 2019
  • Author: Thomas E Herchline, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

Although both Staphylococcus aureus and Streptococcus pyogenes cause impetigo ,historically, streptococcal infections were the most common, but recent series have indicated S aureus is now the leading cause. Management is based on the number of lesions, the location of the infection (eg, face, eyelid, mouth), and limiting infectivity. [2] The IDSA indicates mupirocin to be the best topical agent, despite some reports of resistance, and older preparations (eg, bacitracin and neomycin) to be much less effective. [2]

Administer oral antibiotic agents effective against both S aureus and S pyogenes in patients with many lesions or in those who do not respond to topical agents. [2] Note that some strains of S pyogenes may cause glomerulonephritis, a rare complication of impetigo, but there is currently no available evidence that treating impetigo will prevent glomerulonephritis. Also note that some strains of S aureus and S pyogenes may be resistant to erythromycin and erythromycin ethylsuccinate. [2]

The IDSA recommends use of the following antibiotics for managing impetigo in adults, with treatment duration of about 7 days (based on the clinical response) [2] :

  • Mupirocin ointment applied topically tid in patients with a limited number of lesions

  • Dicloxacillin, cephalexin, or  erythromycin 250 mg PO qid, or

  • Erythromycin ethylsuccinate 400 mg PO qid, or

  • Clindamycin 300-400 mg PO tid, or

  • Amoxicillin-clavulanate (875/125 mg) PO bid


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