How to Treat Impetigo in Adults and Children

Medically reviewed by Atul S. Vellappally, DNP, CRNP, FNP-BC — Family Nurse Practitioner

Your child comes home from daycare with a few red bumps around their nose that quickly turn into oozing sores topped with a distinctive honey-colored crust. Or perhaps you have noticed a similar rash developing on your own skin after a minor cut or scrape. What you are likely looking at is impetigo, one of the most common bacterial skin infections, particularly in young children. Impetigo accounts for roughly 10 percent of skin problems seen in pediatric clinics, though it can and does affect adults as well.

While impetigo looks alarming, it is usually straightforward to treat with the right antibiotics. The main concerns are its high contagiousness and the need to act quickly to prevent it from spreading to others in the household, classroom, or workplace. This guide covers the types of impetigo, when to use topical versus oral antibiotics, how to manage the contagious period, and how to know when your child — or you — can safely return to normal activities.

Understanding the Types of Impetigo

Non-Bullous Impetigo

Non-bullous impetigo is the most common form, accounting for approximately 70 percent of cases. It is caused by Staphylococcus aureus, Group A Streptococcus (Streptococcus pyogenes), or a combination of both. The infection typically begins as small red papules that quickly evolve into vesicles (tiny fluid-filled blisters) that rupture and develop the characteristic golden or honey-colored crusts. The face is the most common site, particularly around the nose and mouth, though it can appear anywhere on the body. The sores are usually painless or mildly uncomfortable and tend to itch, which unfortunately promotes scratching and further spread.

Non-bullous impetigo often develops at sites of minor skin disruption — insect bites, abrasions, cuts, or areas of existing dermatitis — which provide an entry point for bacteria. In children, it frequently follows a cold or allergic rhinitis, where nasal discharge irritates and breaks down the skin around the nose.

Bullous Impetigo

Bullous impetigo is caused exclusively by Staphylococcus aureus strains that produce exfoliative toxins. These toxins cause the top layers of skin to separate, forming larger, fluid-filled blisters (bullae) that are typically one to two centimeters in diameter. The blisters contain clear or cloudy yellowish fluid and can persist for longer than the smaller vesicles of non-bullous impetigo before rupturing. After they burst, they leave shallow, red, moist erosions with a thin, varnish-like crust rather than the thick honey-colored crust of non-bullous impetigo.

Bullous impetigo is more common in infants and young children and tends to favor the trunk, arms, and diaper area. It can appear on intact skin without an obvious preceding injury, which distinguishes it from non-bullous forms.

Ecthyma

Ecthyma is a deeper form of impetigo that extends through the epidermis into the dermis, producing thick, adherent crusts overlying shallow ulcers. It is sometimes called "deep impetigo" and tends to occur when superficial impetigo is left untreated, particularly in patients with poor hygiene, malnutrition, or immunosuppression. Ecthyma sores are more painful than typical impetigo and can leave scars. This form almost always requires oral antibiotic therapy.

Topical Antibiotic Treatment

Topical antibiotics are the first-line treatment for localized, uncomplicated impetigo with only a few lesions and no systemic symptoms (such as fever). Treating topically limits antibiotic exposure to the affected area, reduces the risk of systemic side effects, and is appropriate for the majority of mild cases.

Mupirocin (Bactroban) is the most commonly prescribed topical antibiotic for impetigo. It is applied to the affected area three times daily for five to seven days, depending on your provider's recommendation. Before application, gently wash the area with soap and water and pat dry, then apply a thin layer of ointment and cover with a bandage if possible. Mupirocin is effective against both Staphylococcus and Streptococcus, the two primary causes of impetigo, and resistance rates remain relatively low in most communities.

Retapamulin (Altabax) is a prescription alternative that is applied twice daily for five days. It belongs to a different antibiotic class (pleuromutilins) and can be useful when mupirocin resistance is a concern. It is approved for use in patients nine months of age and older.

Fusidic acid is commonly used in some countries outside the United States but has more limited availability domestically. When available, it is applied two to three times daily for seven days and has good efficacy against staphylococcal impetigo.

Over-the-counter antibiotic ointments such as bacitracin and triple antibiotic (Neosporin) are sometimes used for very minor skin infections, but they are not recommended as primary treatment for impetigo. Their efficacy against the causative organisms is inferior to mupirocin and retapamulin.

Oral Antibiotic Treatment

Oral antibiotics are recommended when impetigo is widespread (more than five lesions or involving a large area), when the infection is deep (ecthyma), when topical treatment has failed, or when the patient has systemic symptoms such as fever or swollen lymph nodes. Oral treatment is also preferred during outbreaks in close-contact settings to help contain transmission.

Cephalexin (Keflex) is a commonly prescribed oral option that provides broad coverage against both Staphylococcus and Streptococcus. For adults, the typical dose is 250 to 500 mg four times daily for seven days. For children, dosing is weight-based, typically 25 to 50 mg per kilogram per day divided into two to four doses. Cephalexin is generally well-tolerated, with gastrointestinal upset being the most common side effect.

Dicloxacillin is another effective choice, particularly for staphylococcal impetigo. It should be taken on an empty stomach for best absorption. For patients with penicillin allergy, alternatives include clindamycin, azithromycin, or trimethoprim-sulfamethoxazole, depending on the suspected organism and local resistance patterns.

If methicillin-resistant Staphylococcus aureus (MRSA) is suspected based on local prevalence or treatment failure, your provider may prescribe trimethoprim-sulfamethoxazole (Bactrim), clindamycin, or doxycycline (for patients over eight years old). MRSA impetigo may appear similar to regular impetigo but is more likely to be resistant to initial therapy.

Regardless of which antibiotic is prescribed, it is important to complete the full course of treatment, even if the sores improve within the first day or two. Stopping early increases the risk of incomplete clearance and recurrence.

Wound Care and Hygiene During Treatment

Proper wound care supports antibiotic treatment and helps prevent the infection from spreading to new body sites or to other people.

Gentle cleansing is essential. Wash the affected areas two to three times daily with mild soap and warm water. Soak any thick crusts with a warm, wet cloth for a few minutes to soften them, then gently remove them before applying topical antibiotics. Removing the crusts allows the medication to reach the infected tissue underneath and promotes faster healing.

Cover the sores with loose, non-stick bandages whenever possible. This serves a dual purpose: it protects the sores from further irritation and contamination, and it prevents the highly contagious drainage from contacting other people or surfaces. Change bandages at least once daily or whenever they become soiled.

Hand hygiene is critical. Wash hands thoroughly with soap and water before and after touching the sores or applying medication. If the infected person is a child, supervise handwashing and keep their fingernails trimmed short to minimize scratching and spreading.

Avoid sharing personal items including towels, washcloths, bedding, clothing, and razors. Wash the infected person's linens, towels, and clothing daily in hot water during the active infection period. If possible, give the infected individual their own set of towels.

The Contagious Period and Return-to-School Guidelines

Impetigo is highly contagious and spreads through direct skin-to-skin contact with the sores or their drainage, as well as through indirect contact with contaminated items. Without treatment, the infection remains contagious as long as sores are present and draining, which can persist for weeks.

With antibiotic treatment, impetigo is generally considered no longer contagious after 24 to 48 hours of therapy, provided the sores are improving and no new lesions are developing. This timeline forms the basis for most school and daycare return policies.

Most schools and childcare facilities allow return after 24 hours of antibiotic treatment, though some require 48 hours or a healthcare provider's note. All exposed sores should be covered with bandages upon return. It is worth checking your specific school's policy, as requirements vary. A telehealth provider can evaluate your child, start treatment, and provide any required documentation for school readmission.

For adults in workplace settings, the same general principle applies. Most employers do not have formal impetigo policies, but keeping sores covered and maintaining hand hygiene after 24 to 48 hours of treatment is generally sufficient for safe return, particularly in office environments. Those who work in food handling, healthcare, or close-contact settings should confirm with their employer, as stricter guidelines may apply.

Impetigo in Adults

While impetigo is most prevalent in children between ages two and five, adults are not immune. Adult impetigo often occurs in the setting of disrupted skin barriers — eczema, contact dermatitis, herpes simplex sores, or shaving-related abrasions on the face or legs. Athletes in contact sports like wrestling and rugby are at increased risk due to skin abrasion and close physical contact. Adults living in warm, humid climates or crowded conditions also face higher rates of infection.

The treatment approach for adults mirrors that for children: topical antibiotics for limited disease and oral antibiotics for extensive or deep infections. Adults should be aware that impetigo can be a secondary infection complicating an underlying skin condition, so addressing the primary issue (such as managing eczema) is important for preventing recurrence.

Potential Complications

Most impetigo resolves without complications when appropriately treated. However, untreated or inadequately treated infections can lead to several concerning outcomes. The infection can spread locally, developing into cellulitis (a deeper, more serious skin infection) or lymphangitis (infection of the lymphatic system). In rare cases, staphylococcal impetigo can lead to staphylococcal scalded skin syndrome in neonates and very young children.

The most significant though uncommon complication is post-streptococcal glomerulonephritis (PSGN), a kidney condition that can follow Group A Streptococcal skin infections. PSGN typically develops one to three weeks after the skin infection and presents with dark or cola-colored urine, facial puffiness, reduced urine output, and elevated blood pressure. While PSGN is self-limited in most cases, it requires medical monitoring. Importantly, antibiotic treatment of impetigo does not appear to prevent PSGN, but it does help limit spread to others and speed healing.

When to Seek Care

You should seek evaluation for any rash that develops rapidly, produces pus or honey-colored crusting, or appears to be spreading. Prompt treatment is particularly important for infants, for infections near the eyes, for anyone with diabetes or immune compromise, and when the infection does not respond to initial treatment within 48 to 72 hours. Seek more urgent evaluation if there is associated fever, rapidly expanding redness, significant swelling, or red streaks extending from the sores, as these may indicate a deeper infection requiring more aggressive treatment.

Frequently Asked Questions