Soaks and scrubbing can be beneficial, especially in unroofing lakes of pus under thick crusts. Topical agents, such as mupirocin, ozenoxacin, and retapamulin, are first-line treatment options for infections limited to small areas. In widespread cases, or in immunosuppressed individuals, systemic antibiotics are indicated. Cephalexin, 250 mg orally four times daily, is usually effective. Doxycycline, 100 mg orally twice daily, is a reasonable alternative. Community-associated methicillin-resistant S aureus (CA-MRSA) may cause impetigo, and initial coverage for MRSA could include doxycycline (100 mg orally twice daily) or trimethoprim-sulfamethoxazole (TMP-SMZ, double-strength tablet orally twice daily). About 50% of CA-MRSA cases are quinolone resistant. Recurrent impetigo is associated with nasal carriage of S aureus and is treated with rifampin, 300 mg orally twice daily for 5 days. Intranasal mupirocin ointment twice daily for 5 days clears the carriage of 40% of MRSA strains. Bleach baths (¼ to ½ cup per 20 liters of bathwater for 15 minutes three to five times weekly) for all family members and the use of dilute household bleach to clean showers and other bath surfaces may help reduce the spread. Individuals should not share towels if there is a case of impetigo in the household.