What is the recommended treatment for impetigo (bacterial skin infection) on the neck in a child?

Treatment for Impetigo on the Neck in a Child

Topical mupirocin 2% ointment is the first-line treatment for impetigo on the neck in a child, applied to affected areas 3 times daily for 5-7 days. 1, 2

First-Line Treatment

Topical Therapy

• For limited lesions (recommended first):
  • Mupirocin 2% ointment applied to affected areas 3 times daily for 5-7 days 1, 2
  • Highly effective against both Staphylococcus aureus and Streptococcus pyogenes (the primary causative organisms) 2
  • FDA-approved specifically for impetigo treatment 2
  • Apply a thin layer to cover the affected area completely
  • Continue treatment until lesions are completely healed

Monitoring and Follow-up

• Evaluate clinical response within 48-72 hours of starting treatment 1
• If no improvement is seen within 3-5 days, consider:
  • Alternative diagnosis
  • Bacterial culture and sensitivity testing
  • Switching to oral antibiotics 1

Second-Line Treatment

Oral Antibiotics (for extensive disease or treatment failure)

For more extensive impetigo or when topical therapy is impractical:

• First choice: Cephalexin (weight-appropriate dosing) for 7 days 1
• Alternative options:
  • Amoxicillin/clavulanate (Augmentin) for 7-10 days 1
  • Clindamycin for MRSA coverage or penicillin allergy 1

Important: Trimethoprim-sulfamethoxazole (TMP-SMX) has inadequate streptococcal coverage and should not be used as monotherapy unless MRSA is confirmed 1

Clinical Pearls and Pitfalls

Key Points

• Impetigo is highly contagious and most commonly affects children 2-5 years of age 3, 4
• Presents in two forms: nonbullous (70% of cases) with honey-colored crusts and bullous (30%) with flaccid bullae 3
• Expected resolution is within 7-10 days with appropriate treatment 1

Common Pitfalls to Avoid

1. Inadequate coverage: Ensure treatment covers both S. aureus and S. pyogenes
2. Inappropriate antibiotic selection: Avoid tetracyclines (doxycycline, minocycline) in children under 8 years 1
3. Insufficient duration: Complete the full course of antibiotics even if symptoms improve
4. Failure to consider MRSA: Consider MRSA in recalcitrant cases 1
5. Relying on disinfectants: Topical disinfectants are inferior to antibiotics and should not be used 3, 5

Prevention Measures

• Keep lesions covered when possible
• Use separate towels and linens
• Practice good hand hygiene 1
• Daily change of clothing that contacts affected areas 6

By following this treatment approach, most cases of impetigo will resolve completely within 7-10 days without scarring or complications 3.