Bullous impetigo presents with large, fluid-filled blisters on the skin. Initial management typically involves topical antibiotics applied directly to the affected area. When that first-line approach does not achieve the expected clinical response, an evidence-based next step is available.
Topical antibiotic therapy — agents such as mupirocin, retapamulin, or fusidic acid applied to the skin — is the standard first step. The clinical goal is clear improvement and resolution of the bullous impetigo lesions. If there is no clinical response after three to five days, escalation to a different approach is indicated.
When topical therapy is insufficient, oral antibiotic therapy becomes the appropriate next intervention — a structured, evidence-based course that addresses cases where topical treatment is impractical or has not produced an adequate response.
Adequate clinical response with resolution of the bullous impetigo skin lesions, typically expected within two to three weeks.