Treatment: Impetigo can be treated with topical therapy against S. aureus and streptococcal species. Mupirocin is one such topical agent that is highly effective. The other forms of infection need to be treated with oral antibiotics. Cephalexin or dicloxacillin is a good first choice. In areas with high rates of community-acquired MRSA, one should consider covering for this agent with a sulfa-based medication or a tetracycline derivative in adults. Culturing of the bacterial agent should be done in all cases to select the most effective medication.
Severe cases of cellulitis and all cases of TSS should be treated in the hospital in the appropriate setting. Intravenous antibiotics are always used, and vancomycin is the initial choice until the strain of S. aureus is isolated and sensitivities are assessed. Once the sensitivities of the bacteria have been determined, the antibiotic treatment can be tailored to the individual patient. Patients with TSS often require intensive care with pressure support and respiratory support.
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