Last month we determined the main types of impetigo: non-bullous or impetigo contagiosa and bullous impetigo. Reference was made to a third type called ecthyma. Let us now look at the treatment for this infection.
Most cases of impetigo resolve readily with timely treatment, and do so without complication. There are some potential side effects that must be kept in mind. A rare complication of impetigo caused by strep is a condition called post strep glomerulonephritis (PSGN). This is a complication seen with some strep infections, most notably “strep throat”. It is the result of antibodies that are formed after a strep infection. These directly affect the kidneys and can cause the kidneys to spill blood and protein in the urine. It can be a serious complication that leads to hypertension and may permanently affect the kidneys. The goal in treating the impetigo caused by strep is to eradicate the bacteria all together to minimize the risks of PSGN occurring.
As already mentioned bullous impetigo is caused by staph aureus. Over the past decade or two there has been an increase in the presence of a more resistant form of staph known as Methicillin Resistant Staph aureus (MRSA). This form of staph does not respond to the typical antibiotics that are used to treat it. It has become a real challenge for treating physicians. It is estimated that around 20% of bullous impetigo cases are caused by MRSA. There are a few antibiotics available that are very effective in eradicating MRSA. But the concern is overuse, which will inevitably lead to more resistance. The treating physician must be wise and judicious in prescribing antibiotics for impetigo, and must remember that only bullous impetigo is caused by staph exclusively.
In treating impetigo, the parents should clean the lesions with soap and water to try to gently remove the crusty covering. They might want to use an antibacterial soap for this. They can then apply an antibiotic cream or ointment to the lesions three times a day. It is probably wise to use a prescription strength preparation as there is more resistance being reported to the over-the-counter preparation. The doctor may determine that a small, solitary lesion may sufficiently be treated with a prescription ointment such as Bactroban alone. If there are multiple lesions, he/she may want to treat this with an oral antibiotic. Because of the concern for MRSA, the antibiotic choice MUST be determined by the treating physician.
Other things the parents should do is be sure the child’s fingernails are clipped short. Do not let them share washcloths or bath towels. If the child scrapes his skin, clean the scratch or abrasion well with soap and water and apply an antibacterial ointment to the area. Bacitracin or Neosporin should be sufficient for this.
The big question is when can a child return to day care or school once diagnosed with impetigo? Most experts feel that they can safely return to school after being on an oral antibiotic for at least 24-48 hours. If the patient is involved in a contact sport such as wrestling, it is recommended that they do not participate until they have been on the antibiotic for at least three days.