What is the treatment for impetigo (infectious skin disease) with ulcers on the stomach, hip, and head in a 3-year-old child?

Treatment for Impetigo in a 3-Year-Old with Multiple Ulcers

For a 3-year-old child with impetigo presenting with ulcers on the stomach, hip, and head, the recommended first-line treatment is topical mupirocin 2% ointment applied to the lesions twice daily for 5-10 days. 1

Treatment Algorithm

Step 1: Assessment of Severity

• Limited lesions (few, small ulcers):
  • Use topical therapy alone
• Extensive lesions (multiple areas, large ulcers):
  • Consider oral antibiotics

Step 2: First-Line Treatment Options

For Limited Lesions:

• Topical mupirocin 2% ointment
  • Apply to lesions twice daily for 5-10 days 1
  • Highly effective for localized impetigo in children

For Extensive Disease (multiple ulcers on stomach, hip, and head):

• Oral antibiotic options:
  • Cephalexin: 25-50 mg/kg/day divided in 3-4 doses 1
  • Amoxicillin-clavulanate: 25 mg/kg/day of amoxicillin component in 2 divided doses 1
  • Clindamycin: 20 mg/kg/day in 3 divided doses (if concern for MRSA) 1

Special Considerations for This Case

Since this 3-year-old has multiple ulcers across different body areas (stomach, hip, and head), this represents more extensive disease that may warrant oral antibiotic therapy. The presence of ulcers rather than just superficial lesions suggests deeper involvement that would benefit from systemic treatment.

Important Clinical Pearls:

• Cultures should be obtained if the child has extensive disease, does not respond to initial therapy, or if MRSA is suspected 1
• Duration of therapy: 5-10 days, based on clinical response 1
• Tetracyclines should not be used in children under 8 years of age 1
• Penicillin V alone is not recommended as it has poor efficacy against S. aureus 2, 3

Wound Care Instructions

1. Keep all lesions covered with clean, dry bandages 1
2. Maintain good personal hygiene with regular bathing 1
3. Clean hands frequently with soap and water or alcohol-based sanitizer 1
4. Avoid sharing personal items (towels, clothing) 1

For Recurrent Infections

If the child experiences recurrent impetigo after treatment:

1. Consider decolonization with mupirocin nasal ointment twice daily for 5-10 days 1
2. Consider chlorhexidine baths or dilute bleach baths (¼ cup per ¼ tub of water for 15 minutes twice weekly) 1
3. Evaluate family members for asymptomatic carriage 1

When to Consider Hospitalization

• Extensive disease with systemic symptoms (fever, lethargy)
• Failure to respond to oral antibiotics
• Suspected progression to more serious infection
• Inability to maintain adequate oral intake

In these cases, IV antibiotics such as clindamycin (10-13 mg/kg/dose every 6-8 hours) may be indicated 1.

Follow-up

The child should show improvement within 48-72 hours of starting appropriate therapy. If no improvement is seen, reassess the diagnosis, consider obtaining cultures, and consider changing antibiotics to cover potential resistant organisms.