What is the best treatment for impetigo (contagious skin infection) on a 5-year-old's face?

Treatment of Impetigo on a 5-Year-Old's Face

For a 5-year-old child with impetigo on the face, mupirocin 2% topical ointment applied three times daily for 7 days is the recommended first-line treatment. 1, 2

Treatment Algorithm

First-Line Treatment:

• Topical mupirocin 2% ointment
  • Apply to affected areas three times daily for 7 days
  • Clinical efficacy rates of 93-94% in pediatric populations 2
  • Particularly appropriate for localized, non-bullous impetigo 1

When to Consider Oral Antibiotics (Second-Line):

Oral antibiotics should be considered if:

• Extensive facial involvement
• Multiple lesions
• Significant surrounding cellulitis
• Systemic symptoms (fever)
• Topical therapy is impractical
• Failed response to topical therapy

Oral Antibiotic Options for Children:

1. Clindamycin (10-13 mg/kg/dose PO every 6-8 hours, not to exceed 40 mg/kg/day) 1

   • Covers both Staphylococcus aureus and beta-hemolytic streptococci
   • Consider if both MRSA and streptococcal coverage desired

2. Cephalexin (first-generation cephalosporin)

   • For suspected methicillin-susceptible S. aureus (MSSA)
   • Not effective against MRSA

3. Trimethoprim-sulfamethoxazole (TMP-SMX) + amoxicillin 1

   • TMP-SMX alone does not adequately cover streptococcal infections
   • Combination provides coverage for both MRSA and streptococci

IMPORTANT: Tetracyclines (doxycycline, minocycline) should NOT be used in children under 8 years of age 1

Clinical Considerations

Types of Impetigo:

• Non-bullous impetigo (70% of cases) 3

  • Characterized by honey-colored crusts
  • Caused by S. aureus or Streptococcus pyogenes

• Bullous impetigo (30% of cases) 3, 4

  • Large, flaccid bullae
  • Caused exclusively by S. aureus
  • May require oral antibiotics more often

Duration of Treatment:

• 7 days is typically sufficient for topical mupirocin 2
• 5-10 days for oral antibiotics, based on clinical response 1

Hygiene Measures to Prevent Spread:

• Keep lesions covered with clean, dry bandages
• Regular handwashing with soap and water
• Avoid sharing personal items (towels, washcloths)
• Daily bathing with antibacterial soap may help 1

Common Pitfalls to Avoid:

1. Using topical disinfectants - These are inferior to antibiotics and not recommended 3, 5
2. Prescribing oral penicillin V - Seldom effective for impetigo 5
3. Using tetracyclines in young children - Contraindicated under age 8 1
4. Not covering lesions - Increases risk of transmission to others
5. Inadequate duration of therapy - Can lead to treatment failure

Impetigo typically resolves within 2-3 weeks without scarring when properly treated 3. Complications are rare, with poststreptococcal glomerulonephritis being the most serious potential complication.