Treatment of Bullous Impetigo with Suspected MRSA Skin Infection

Clinical Scenario

This protocol addresses bullous impetigo in patients with a suspected methicillin-resistant Staphylococcus aureus (MRSA) skin infection, where standard antibiotic selection may be insufficient.

Key Consideration

When MRSA is suspected, antibiotic selection must provide adequate MRSA coverage. Initial treatment is guided by clinical suspicion and continued pending confirmatory culture results.

Treatment Approach

The protocol specifies an oral antibiotic regimen with MRSA coverage, pending culture results. The clinical goal is adequate response with resolution of impetigo skin lesions — typically within two to three weeks.

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References

If MRSA infection is suspected, initial treatment with trimethoprim/sulfamethoxazole, clindamycin, or a tetracycline (doxycycline or minocycline [Minocin]) is recommended pending culture results.

Treatment for seven days is usually sufficient, but this can be extended if the clinical response is inadequate and antibacterial susceptibility has been confirmed.

It usually resolves within two to three weeks without scarring.

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