What is the most common cause (MCC) of impetigo in a 4-year-old?

From the Guidelines

The most common cause (MCC) of impetigo in a 4-year-old child is Staphylococcus aureus, followed by group A beta-hemolytic streptococci (Streptococcus pyogenes). According to the guidelines for the diagnosis and management of skin and soft tissue infections 1, treatment typically involves topical antibiotics for localized infections. For a 4-year-old child, topical mupirocin ointment applied to affected areas twice daily is a recommended treatment option, as stated in the guidelines 1. For more extensive impetigo, oral antibiotics are recommended, with first-line options including cephalexin (25-50 mg/kg/day divided into 3-4 doses) or clindamycin (20 mg/kg/day divided into 3 doses) for 7 days, as outlined in the guidelines 1.

Some key points to consider in the management of impetigo in a 4-year-old child include:

• Good hygiene practices are essential to prevent the spread of infection, including daily bathing with antibacterial soap, keeping the child's nails short, washing hands frequently, and avoiding sharing towels or clothing.
• The infection typically develops after bacteria enter the skin through cuts, scrapes, or insect bites, with children being particularly susceptible due to their developing immune systems and frequent close contact with other children, as noted in a study on the diagnosis and management of skin and soft-tissue infections 1.
• In areas with high MRSA prevalence, alternative treatment options may be considered, such as clindamycin or trimethoprim-sulfamethoxazole, as discussed in the guidelines 1.

From the Research

Most Common Cause of Impetigo

• The most common cause of impetigo in children is Staphylococcus aureus or Streptococcus pyogenes 2, 3, 4, 5, 6

Types of Impetigo

• There are two principal types of impetigo: nonbullous (70% of cases) and bullous (30% of cases) 2, 3, 4, 5

Characteristics of Nonbullous Impetigo

• Nonbullous impetigo is characterized by honey-colored crusts on the face and extremities 2, 3, 5

Characteristics of Bullous Impetigo

• Bullous impetigo results in large, flaccid bullae and is more likely to affect intertriginous areas 2, 3, 4, 5

Treatment of Impetigo

• Treatment includes topical antibiotics such as mupirocin, retapamulin, and fusidic acid 2, 4, 5
• Oral antibiotic therapy can be used for impetigo with large bullae or when topical therapy is impractical 2, 4, 5, 6
• Amoxicillin/clavulanate, dicloxacillin, cephalexin, clindamycin, doxycycline, minocycline, trimethoprim/sulfamethoxazole, and macrolides are options, but penicillin is not 2, 6