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Oral antibiotic therapy for impetigo*

Medication	Adult dose	Child dose^¶
Preferred
Cephalexin or	250 to 500 mg 4 times per day	25 to 50 mg/kg per day in 3 to 4 divided doses
Dicloxacillin	250 to 500 mg 4 times per day	25 to 50 mg/kg per day in 4 divided doses
Alternate for penicillin and cephalosporin hypersensitivity
Erythromycin (base)^Δ or	250 mg 4 times per day	40 mg/kg per day in 3 to 4 divided doses
Clarithromycin^Δ	250 mg twice per day	15 mg/kg per day in 2 divided doses
If MRSA is suspected or confirmed
Doxycycline^◊ or	100 mg twice per day	2 to 4 mg/kg per day in 2 divided doses
Trimethoprim-sulfamethoxazole or	1 to 2 double-strength tablets twice per day	8 to 12 mg/kg (trimethoprim) per day in 2 divided doses
Clindamycin^§	450 mg 3 times per day	30 mg/kg per day in 3 divided doses

Oral antibiotic therapy is indicated for ecthyma, impetigo with numerous lesions, or to control transmission during outbreaks. A 7-day course of oral antibiotic treatment is recommended.

MRSA: methicillin-resistant Staphylococcus aureus.
* Doses listed in table are for patients with normal renal function; the doses of some agents must be adjusted in patients with renal insufficiency.
¶ Maximum single dose should not exceed dose for adults.
Δ Some strains of Staphylococcus aureus and beta-hemolytic streptococci may be resistant to macrolides.
◊ Although tetracyclines can cause permanent tooth discoloration in children younger than 8 years, doxycycline binds less to calcium than do other tetracyclines. Therefore, short courses of doxycycline (21 days or less) can be given to children who fall within this age group.
§ Potential cross resistance in erythromycin-resistant isolates; inducible resistance in MRSA.

Courtesy of authors with additional data from Stevens DL et al. IDSA Practice Guidelines for SSTIs. CID 2014; 59:147.

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