Treatment of Impetigo: Oral Antibiotics Most Commonly Prescribed
April 2012 | Volume 11 | Issue 4 | Original Article | 489 | Copyright © April 2012
Impetigo is a highly contagious, superficial skin disease that is frequently seen in children. While data support the use
of topical antibiotics for treatment, the medications actually prescribed in practice are not well documented.
To determine the prescribing pattern of dermatologists and nondermatologists when treating impetigo and the demographics
of the patients treated.
National Ambulatory Medical Care Survey data on office visits for impetigo were analyzed from 1997 to 2007. Patient
demographics and the treatments for impetigo were recorded.
During this 10-year period, dermatologists managed an estimated 274,815 impetigo visits and nondermatologists an estimated
3,722,462 visits. Both dermatologists and nondermatologists most frequently prescribed oral antibiotics to treat impetigo.
Topical antibiotics were second most common, and a variety of combination treatments were used.
Oral antibiotics are the most common class of medications used to treat impetigo. There is an opportunity for physicians
to take advantage of the equally efficacious topical antibiotics for treating impetigo. A shift towards topical antibiotics would
likely decrease morbidity (resulting from adverse effects) associated with use of oral agents.
J Drugs Dermatol. 2012;11(4):489-494.
Impetigo is a common, highly contagious, superficial bacterial infection of the skin. The infection is due to Staphylococcus aureus 70%, of the time, but can also be caused by
concurrent Streptococus pyogenes organisms. Two forms of impetigo exist: bullous and nonbullous (crusted) impetigo. In bullous impetigo, patients develop flacid bullae that often rupture
resulting in a dried yellowish crust. The bullae result from the
elaboration of exfoliative toxin by S. aureus. Nonbullous impetigo presents as erythematous macules or papules that become
tiny vesicles that rupture leaving a honey-colored crust. Impetigo
affects patients of all ages, genders, and races, but most commonly children less than 10 years of age.1-3
Impetigo can be treated with topical or oral antibiotics. Topical
and oral agents have equal efficacy; however, in severe cases,
oral antibiotics may be more effective, although the data are
unclear. Topical antibiotics have a lower side effect profile than
oral agents .4,5While the use of topical antibiotics may be desirable in the management of typical impetigo, physician practice
in this regard is not well characterized. Better understanding of physicians' approaches to impetigo management will allow a
comparison with evidence-based guidelines and identify opportunities to decrease morbidity.
The primary objective of this study is to determine the main
treatments being prescribed for impetigo and how they differ
between dermatologists and non-dermatologists. Secondary
objectives include identifying the demographics of impetigo
patients and trends in treatment.
After approval from our Institutional Review Board, we used data
from the National Ambulatory Medical Care Survey (NAMCS)
to assess treatments and demographics of patients at medical
visits for impetigo. The NAMCS acquires nationwide outpatient
data from United States' non-federally employed physicians. The
survey uses a multistage probability sample design, which produces unbiased national estimates, in which the basic sampling
unit is the physician-patient visit. During a randomly assigned
one-week reporting period, the physician records information