Treatment for Cold, Sore Nose, and Perioral Impetigo
For this 39-year-old woman, treat the perioral impetigo with topical mupirocin 2% ointment applied three times daily for 8-12 days, and manage the cold symptoms with supportive care including analgesics (ibuprofen or paracetamol) and short-term nasal decongestants if needed for severe congestion. 1
Impetigo Treatment (Primary Concern)
Topical antibiotic therapy is the treatment of choice for localized impetigo:
Mupirocin 2% ointment applied three times daily for 8-12 days is FDA-approved and highly effective for impetigo caused by Staphylococcus aureus and Streptococcus pyogenes, achieving 71-93% clinical efficacy rates. 1
Topical mupirocin is superior to oral erythromycin for pathogen eradication (100% vs 78.5%) and produces equivalent or better clinical outcomes while avoiding systemic side effects. 1, 2
Topical antibiotics show significantly better cure rates than placebo (OR 6.49,95% CI 3.93-10.73) and are equally or more effective than oral treatment for limited disease. 3
Oral antibiotics should be reserved only if the impetigo is extensive (multiple body areas affected), though this patient's perioral distribution suggests localized disease amenable to topical therapy. 4, 5
Common Cold Management (Supportive Care Only)
Antibiotics have no role in treating the common cold and cause more harm than benefit:
There is no evidence that antibiotics provide benefit for common cold, and they cause significant adverse effects in adults. 6
The common cold is self-limited, typically resolving within 2 weeks without treatment. 6
Symptomatic relief options include:
Analgesics: Ibuprofen or paracetamol for pain relief, sore throat, and malaise. NSAIDs significantly improve headache, ear pain, and muscle/joint pain associated with colds. 6
Nasal decongestants (short-term only): Topical decongestants (e.g., oxymetazoline) may provide modest relief for severe nasal congestion but should be limited to 3 days maximum to avoid rhinitis medicamentosa (rebound congestion). 6
Saline nasal irrigation can help with nasal symptoms without risk of adverse effects. 6
Critical Caveats and Pitfalls
Avoid these common errors:
Do not use topical decongestants beyond 3 days as rebound congestion may develop as early as day 3-4 of regular use. 6
Do not prescribe oral antibiotics for the cold component - antihistamines, decongestants, and combination products have limited or no proven benefit for common cold symptoms and increase adverse effects. 6
Do not use topical disinfectants for impetigo as they are not effective. 4, 3
Ensure the patient understands that the cold will resolve naturally over 7-14 days regardless of treatment, while the impetigo requires the full course of topical antibiotic. 6, 1
Expected Clinical Course
Impetigo: Clinical improvement should be evident within 3-5 days of starting mupirocin, with complete resolution by 8-12 days. 1
Cold symptoms: Natural resolution occurs within 7-14 days without specific treatment. 6
Instruct the patient to return if impetigo worsens or spreads despite treatment, or if cold symptoms persist beyond 10 days or worsen after initial improvement (suggesting possible bacterial sinusitis). 6, 7