Do Antimicrobial Resistance Patterns Matter? An Algorithm for the Treatment of Patients With Impetigo

J Drugs Dermatol. 2021 Feb 1;20(2):134-142. doi: 10.36849/JDD.5745.


Background: Impetigo, a highly contagious bacterial skin infection commonly occurring in young children, but adults may also be affected. The superficial skin infection is mainly caused by Staphylococcus aureus (S. aureus) and less frequently by Streptococcus pyogenes (S. pyogenes). Antimicrobial resistance has become a worldwide concern and needs to be addressed when selecting treatment for impetigo patients. An evidence-based impetigo treatment algorithm was developed to address the treatment of impetigo for pediatric and adult populations.

Methods: An international panel of pediatric dermatologists, dermatologists, pediatricians, and pediatric infectious disease specialists employed a modified Delphi technique to develop the impetigo treatment algorithm. Treatment recommendations were evidence-based, taking into account antimicrobial stewardship and the increasing resistance to oral and topical antibiotics.

Results: The algorithm includes education and prevention of impetigo, diagnosis and classification, treatment measures, and follow-up and distinguishes between localized and widespread or epidemic outbreaks of impetigo. The panel adopted the definition of localized impetigo of fewer than ten lesions and smaller than 36 cm2 area affected in patients of two months and up with no compromised immune status. Resistance to oral and topical antibiotics prescribed for the treatment of impetigo such as mupirocin, retapamulin, fusidic acid, have been widely reported.

Conclusions: When prescribing antibiotics, it is essential to know the local trends in antibiotic resistance. Ozenoxacin cream 1% is highly effective against S. pyogenes and S. aureus, including methycyllin-susceptible and resistant strains (MRSA), and may be a suitable option for localized impetigo.J Drugs Dermatol. 2021;20(2):134-142. doi:10.36849/JDD.5475 THIS ARTICLE HAD BEEN MADE AVAILABLE FREE OF CHARGE. PLEASE SCROLL DOWN TO ACCESS THE FULL TEXT OF THIS ARTICLE WITHOUT LOGGING IN. NO PURCHASE NECESSARY. PLEASE CONTACT THE PUBLISHER WITH ANY QUESTIONS.

Publication types

  • Review

MeSH terms

  • Aminopyridines / pharmacology
  • Aminopyridines / therapeutic use
  • Anti-Bacterial Agents / pharmacology
  • Anti-Bacterial Agents / therapeutic use*
  • Antimicrobial Stewardship / standards
  • Bridged Bicyclo Compounds, Heterocyclic / pharmacology
  • Bridged Bicyclo Compounds, Heterocyclic / therapeutic use
  • Critical Pathways / standards*
  • Delphi Technique
  • Diterpenes / pharmacology
  • Diterpenes / therapeutic use
  • Drug Resistance, Bacterial
  • Evidence-Based Medicine / standards
  • Fusidic Acid / pharmacology
  • Fusidic Acid / therapeutic use
  • Humans
  • Impetigo / diagnosis
  • Impetigo / drug therapy*
  • Impetigo / microbiology
  • Microbial Sensitivity Tests / standards
  • Mupirocin / pharmacology
  • Mupirocin / therapeutic use
  • Practice Guidelines as Topic
  • Quinolones / pharmacology
  • Quinolones / therapeutic use
  • Skin Cream / pharmacology
  • Skin Cream / therapeutic use
  • Staphylococcus aureus / drug effects*
  • Staphylococcus aureus / isolation & purification
  • Streptococcus pyogenes / drug effects*
  • Streptococcus pyogenes / isolation & purification
  • Systematic Reviews as Topic


  • Aminopyridines
  • Anti-Bacterial Agents
  • Bridged Bicyclo Compounds, Heterocyclic
  • Diterpenes
  • Quinolones
  • retapamulin
  • Fusidic Acid
  • Mupirocin
  • ozenoxacin