Impetigo (localized and systemic)

Apply 2% cream or ointment TID to affected lesions x 5 days

Apply 2% cream or ointment TID to affected lesions for 5 days

Alternatives. The entry names fusidic acid first-line for localised non-bullous impetigo, with mupirocin kept for suspected fusidic-acid resistance.

Fucidin 20 mg/g Cream (fusidic acid) SmPC sections 4.1 and 4.2 (eMC product 5510): "Fucidin 20 mg/g cream is indicated either alone or in combination with systemic therapy, in the treatment of primary and secondary skin infections caused by sensitive strains of Staphylococcus aureus, Streptococcus spp and Corynebacterium minutissimum." and "Uncovered lesions - apply gently three or four times daily." The 5-day course sits inside that frequency; the SmPC states no duration.

First-line topical treatment for localized non-bullous impetigo

Apply 2% ointment TID to affected skin area x 5 days

Apply 3 times a day for 5 days. Licenses for mupirocin use in infants vary between products; check individual SPCs.

Mupirocin ointment USP 2% US prescribing information, INDICATIONS AND USAGE and DOSAGE AND ADMINISTRATION (DailyMed SetID b8e115ce-c8ff-4d08-b865-71dc4d0e51a1): "Mupirocin ointment is indicated for the topical treatment of impetigo due to susceptible isolates of Staphylococcus aureus and Streptococcus pyogenes." and "Apply a small amount of mupirocin ointment, with a cotton swab or gauze pad, to the affected area 3 times daily for up to 10 days." The 5-day course sits inside the label's 10-day ceiling.

Alternative topical treatment when fusidic acid resistance is suspected

500 mg BID for widespread or severe impetigo

30 mg/kg/day [child max 1000 mg]

(30 mg/kg/day in 2 divided doses for widespread impetigo)

Egyptian National Drug Formulary - Antimicrobial 2023 (cefadroxil monograph)

Oral antibiotic for widespread or complicated impetigo

150 to 300 mg every 6 hours by mouth, rising to 300 to 450 mg every 6 hours in more severe disease x 7 days

8-20 mg/kg/day

(8 to 20 mg/kg/day by mouth, divided every 6 to 8 hours, using the capsule (hydrochloride) salt. Not for infants under one month.)

Alternatives, and clindamycin is the one to reach for first. It is the only one of the three the Egyptian formulary lists for skin and soft tissue infection outright, it covers streptococcus as well as MRSA, and it has a paediatric oral dose with no age floor beyond the newborn - which matters on a disease most often seen in children. Doxycycline is reserved above 8 years, and co-trimoxazole cannot be relied on against group A streptococcus.

Egyptian Drug Authority - National Guidance of Rational Antimicrobial Use in the Management of Skin and Soft Tissue Infection, EDREX:GU.CAP.Care.015 version 1, 11/2025 - verbatim, on impetigo: "When MRSA is suspected or confirmed: One of the following: Doxycycline. SMX-TMP. Clindamycin", with the course length "Oral therapy for ecthyma or impetigo should be a7-day." and the adult dose "300-400 mg 4 times per day po." / "MRSA: 600-900 mg every 8 h IV or 300 mg 4 times daily or 450 mg 3 times." | Egyptian National Drug Formulary - antimicrobial-2023.pdf, Clindamycin monograph (chapter PDF p287) - verbatim, for the indication and the paediatric dose: "Skin and soft tissue infection: Treatment of skin and soft tissue infection" and "Oral: Infants, Children, and Adolescents: Hydrochloride salt (capsule): 8 to 20 mg/kg/day divided every 6 to 8 hours."

Covers methicillin-resistant Staphylococcus aureus and Streptococcus pyogenes in one drug, which matters in impetigo because streptococcus causes a large share of it.

100 mg twice daily by mouth x 7 days

2.2 mg/kg/dose [child max 100 mg]

(2.2 mg/kg per dose every 12 hours, never above 100 mg in a dose - but see the age restriction in the cautions before using this in a child.)

Egyptian Drug Authority - National Guidance of Rational Antimicrobial Use in the Management of Skin and Soft Tissue Infection, EDREX:GU.CAP.Care.015 version 1, 11/2025 - verbatim, on impetigo: "When MRSA is suspected or confirmed: One of the following: Doxycycline.", with the course length "Oral therapy for ecthyma or impetigo should be a7-day." and the adult dose "100 mg orally or IV 2 times per day." | Egyptian National Drug Formulary - Antimicrobial 2023 (doxycycline monograph) - verbatim, for the paediatric dose: "Children and Adolescents: Oral, IV: 2.2 mg/kg/dose every 12 hours, maximum dose: 100 mg/dose."

An MRSA-active oral option that is stocked everywhere in Egypt and costs a few pounds a course.

1 to 2 double-strength tablets (800 mg sulphamethoxazole with 160 mg trimethoprim) twice daily x 7 days

6-12 mg/kg/day [child max 320 mg]

(6 to 12 mg/kg/day divided every 12 hours, counted on the TRIMETHOPRIM component alone, not on the combined tablet weight, to a ceiling of 160 mg of trimethoprim in a single dose. The 200/40 mg per 5 mL suspension carries 40 mg of trimethoprim in each 5 mL. Not under 2 months of age.)

Egyptian Drug Authority - National Guidance of Rational Antimicrobial Use in the Management of Skin and Soft Tissue Infection, EDREX:GU.CAP.Care.015 version 1, 11/2025 - verbatim, on impetigo: "When MRSA is suspected or confirmed: One of the following: ... SMX-TMP.", with the course length "Oral therapy for ecthyma or impetigo should be a7-day." and the adult dose "1 or 2 double-strength tablets 2 times per day." | Egyptian National Drug Formulary - Antimicrobial 2023, sulfamethoxazole and trimethoprim monograph - verbatim, for the paediatric dose: "General dosing, susceptible infection: Infants >=2 months, Children, and Adolescents: Oral, IV: 6 to 12 mg TMP/kg/day in divided doses every 12 hours; maximum single dose: 160 mg TMP/dose"

MRSA-active, widely stocked and cheap - but the narrowest of the three options here, because it cannot be relied on against streptococcus.