Impetigo is treated with antibiotics, either applied directly to the skin or taken by mouth, depending on how widespread the infection is. Most cases with just a few sores clear up with a prescription topical antibiotic within seven days. The key to effective treatment is removing the crusty scabs before applying medication so the antibiotic can actually reach the infection underneath.
Topical Antibiotics for Mild Cases
For localized, uncomplicated impetigo with only a handful of sores, a prescription topical antibiotic is the standard first-line treatment. Mupirocin is the most commonly prescribed option. You apply it directly to the sores, typically two to three times a day for about seven days. Retapamulin is another prescription option that works similarly.
Before each application, you need to prepare the skin. Soak the affected area in warm water or hold a wet cloth compress against it for a few minutes. Pat the area dry, then gently peel away any scabs or crusts. This step matters because the dried, honey-colored crusts that characterize impetigo act as a barrier. If you skip this, the antibiotic sits on top of dead crust instead of penetrating to where the bacteria live.
Over-the-counter antibiotic ointments like bacitracin or triple antibiotic creams are not reliable substitutes. In clinical trials, bacitracin performed no better than placebo in one study and was inferior to prescription oral antibiotics in another. If you suspect impetigo, a prescription topical is worth the visit.
When Oral Antibiotics Are Needed
Your doctor will likely prescribe oral antibiotics instead of (or alongside) a topical if any of the following apply:
- More than five sores or sores spread across a large area
- Bullous impetigo, the type that forms large, fluid-filled blisters rather than small crusty sores
- Signs of deeper infection, such as swollen lymph nodes, fever, or tissue involvement beyond the surface
- Sores inside the mouth or in areas where applying a topical cream is impractical
A seven-day course is standard. The most commonly used oral antibiotic is cephalexin, which covers both staph and strep bacteria. If your doctor suspects MRSA (a drug-resistant staph strain), clindamycin or doxycycline are the typical alternatives. Treatment can be extended if the infection hasn’t responded after the first week, but most people see clear improvement within a few days of starting.
The Two Types Require Different Approaches
Non-bullous impetigo is the most common form, accounting for the majority of cases. It starts as small red sores, usually around the nose or mouth, that rupture and leave behind golden-yellow crusts. This is the type that often responds to topical treatment alone when caught early and limited to a small area.
Bullous impetigo produces larger blisters filled with clear or cloudy fluid. These blisters are more fragile, break easily, and leave behind red, raw patches. Because it tends to be caused by toxin-producing staph bacteria and is generally more aggressive, all cases of bullous impetigo call for oral antibiotics regardless of how many sores are present.
Keeping It From Spreading
Impetigo is highly contagious through direct contact with the sores or with items that have touched them, like towels, clothing, or bedding. Once you or your child starts antibiotic treatment, the CDC considers the infection no longer contagious after at least 12 hours. Children can return to school or daycare at that point, as long as they appear well. In certain situations, such as outbreaks at a daycare or infections in healthcare workers, waiting a full 24 hours is recommended.
During the contagious period and throughout treatment, practical steps make a real difference. Keep fingernails short to reduce scratching and spreading bacteria to new skin. Wash towels, pillowcases, and clothing in hot water and don’t share them. Cover open sores loosely with a bandage when possible. Wash your hands thoroughly after touching the infected area or applying medication.
What to Watch For During Treatment
Most impetigo heals without scarring and without complications. Systemic symptoms like fever are uncommon with typical cases. Regional lymph nodes near the infection site can swell, but this usually resolves as the antibiotics work.
The more serious risk, though rare, is a kidney complication called post-streptococcal glomerulonephritis. This can develop one to two weeks after a strep-caused skin infection, even after the impetigo itself has healed. Signs include dark or cola-colored urine, puffiness around the eyes or in the legs, and decreased urine output. Notably, research has not conclusively shown that treating impetigo with antibiotics prevents this kidney complication in individual cases. The main reasons to treat are to speed healing, limit spread, and prevent the infection from going deeper into the skin.
If sores are spreading despite 48 to 72 hours of treatment, if new blisters keep forming, or if you develop fever or significant swelling around the sores, the infection may need a different antibiotic or closer evaluation. Impetigo that deepens into the skin can progress to cellulitis, a more serious infection requiring stronger treatment.
Preventing Recurrence
Impetigo tends to take hold where the skin barrier is already broken. Insect bites, eczema patches, cuts, and scrapes all create entry points for the bacteria. Keeping existing skin conditions well managed and cleaning minor wounds promptly reduces the chance of impetigo developing in the first place. In children with eczema, flares deserve prompt attention partly because the disrupted skin is an easy target for staph and strep.
Some people, particularly children in close-contact settings like daycare, get recurrent episodes. Bacteria can colonize the inside of the nose and reinfect the skin repeatedly. In these cases, applying mupirocin inside the nostrils for several days can help eliminate the bacterial reservoir and break the cycle.