Supplement Detective

By Curtis Alexander, Pharm.D.

Summary: The most effective impetigo treatment is topical antibiotics like Bactroban® and Altabax®.  Oral antibiotics can be used but is rare.  If you don’t treat it may take up to two weeks for impetigo to clear.

Q: What is the best impetigo treatment?

A: Impetigo is the scourge of my family.  My wife just started getting it again and immediately started with her preferred treatment – which I’ll get to in a second.  But first a little background.

What is Impetigo?

Impetigo is a highly contagious bacterial infection (staph mostly, sometimes strep).  It’s also very bothersome in the fact that in most cases it spreads rapidly, particularly in children and looks terrible.

Because of how contagious it is you tend to see it on the face, particularly around the mouth as it is passed through direct contact (kissing) or indirect (drinking from the glass of someone who has impetigo).  However, it can show up on any part of the body.

Treatments for Impetigo

The best impetigo treatment I’ve come across is topical antibiotics.  Particularly mupirocin (Bactroban®) .  A new product, retapamulin (Altabax®) is also promising but much more expensive.

The downside of these options (besides Altabax’s cost) is that you must have a doctors prescription get them.  So you’ll have to pay for a doctors visit.

However, once you have a supply it will likely last you quite a while.  For example, most mupirocin tubes are 22 grams.  That should last well over a year depending on the number of outbreaks and the size of the family or number of people using it.

In addition, once the year is up and you have to get more it’s usually as simple as calling your doctor and having him send a prescription to your pharmacy for more.  Since impetigo is common your doctor likely won’t require you to be seen again.

If I had to recommend one it would be mupirocin because of the cost savings.

However, there is one exception: recently our pharmacy had samples of Altabax so make sure to ask your doctor about that.  It could save you a lot of money.

Oral Antibiotics

Again, since impetigo is bacterial some doctors may opt to have you take an antibiotic by mouth (particularly if the impetigo spreads and covers a larger area).

Frankly, I’ve never seen this personally but it does happen.  The drugs of choice tend to be amoxicillin.

As with mupirocin above, you’ll have to see your doctor and get him or her to write a prescription.  Amoxicillin is cheap.

Interestingly, according to the studies we have available oral antibiotics seem to be less effective than topical antibiotics.

Treatment of Impetigo: Other Options

While it’s easier said than done you can certainly let impetigo run its course, which it usually does in two weeks.

You should know though, that impetigo isn’t completely safe.  In rare instances it can lead to cases of glomerulonephritis (a kidney disorder).  However, treatment doesn’t seem to have any effect on whether it can develop.

Letting impetigo run its course is something that I’d only recommend for adults as kids have a tendency to rub and scratch the ‘pustules’ that are a hallmark of impetigo.  Once they do it spreads and continues to do so.

For adults you can try and contain it without treating it by simply letting the pustules come to a head and then gently dab it with a warm, damp washcloth.  Within a day it will likely scab over and if it hasn’t spread it will be gone in a week or two.

Another option – and this isn’t for the faint of heart - is to use the above procedure but instead of letting it just scab over do the following.

Pour some table salt into your hand and then place a little water with the salt.  The idea is to form a kind of ’salt paste’.  And then, you guessed it, place that paste on the open impetigo spot.

Yes, it stings like crazy.  But it also does one other thing: it tends to dry the area out preventing any further spread.  In my experience it also speeds the healing process as when I have done this the scar is generally gone within 5 to 7 days rather than the one to two weeks it would take by doing nothing.

Impetigo Prevention

If my wife or myself break out with impetigo it almost always happens when we are stressed.  In other words or immune systems are run down and it makes it easier for the bacteria to take hold.

If you do think you have impetigo you’ll want to see a doctor or ask someone who had it as its very common.  If you do, don’t mess with the sores too much.

When I first got impetigo at age 20 I thought it was a weird zit and ended up trying to pop it.  More ‘zits’ showed up.  So I popped them.  Eventually my girlfriend (remember the kissing comment above?) just kind of smiled and said it wasn’t acne…it was impetigo.  I literally had a spot on my chin, one inch square, that was nothing but dried up pustules and pustules getting ready to pop.  Not an enjoyable experience.

I did manage to forgive the girl though.  She eventually became my wife.

Impetigo and MRSA

Reports of impetigo being caused by MRSA are becoming more and more common.

MRSA is Methicillin Resistant Staphylococcus Aureus.  It’s becoming more and more of a problem because the antibiotics that have been able to treat it in the past are now becoming resistant.  So, rather than MRSA just showing up in the hospitals and nursing homes like it use to, we are now seeing it in otherwise healthy kids and adults.

Ideally, every infection should be ‘kicked’ on our own…with our own immune systems.  Of course, that’s not as convenient as taking a pill or applying a cream.  But, when people don’t take all of their antibiotic or apply the antibiotic cream long enough (say, until the infection clears up and then 3 extra days) you end up having extremely strong bacteria make it through the treatment.  Then, they replicate and produce newer strains of stronger bacteria that our antibiotics don’t work against.

While this probably isn’t something to concern yourself with it’s important for you to know about.  Particularly if you use an antibiotic for the impetigo and it doesn’t go away.

Tags: impetigo and treatment, impetigo treatments, treatment for impetigo, treatment of impetigo, treatments of impetigo

This entry was posted on Tuesday, November 10th, 2009 at 12:43 am and is filed under Skin Treatments. You can follow any responses to this entry through the RSS 2.0 feed. Responses are currently closed, but you can trackback from your own site.