What is the recommended treatment and patient education for a healthy 5‑year‑old child with impetigo?

Patient Education for a 5-Year-Old Child with Impetigo

What Parents Need to Know About Impetigo

Impetigo is a highly contagious bacterial skin infection that will resolve with proper antibiotic treatment, and your child can return to normal activities once treatment begins and lesions start healing. 1, 2

Understanding the Infection

• Impetigo is caused by bacteria (Staphylococcus aureus and/or Streptococcus pyogenes) that colonize the skin surface before causing infection, typically entering through minor cuts, insect bites, or scratches 1
• The infection is most common in children aged 2-5 years and spreads easily through direct skin contact or sharing towels and clothing 1, 3
• Lesions typically appear as honey-colored crusts on the face and extremities, or as fluid-filled blisters that rupture and leave a thin brown crust 1, 3

Treatment Plan

For Limited Disease (Few Small Lesions)

Apply mupirocin 2% ointment to affected areas three times daily for 5-7 days as the first-line treatment. 4, 2, 5

• Gently wash the affected area with soap and water before applying the medication 1
• Apply a thin layer of ointment directly to the lesions and a small area around them 5
• Retapamulin 1% ointment twice daily for 5 days is an alternative if mupirocin is not available 4, 2

For Extensive Disease (Multiple or Large Lesions)

Oral antibiotics are necessary when impetigo covers large areas, involves multiple body sites, or when topical treatment is impractical. 4, 2

• First-choice oral antibiotics include cephalexin or dicloxacillin, dosed by your child's weight 4, 2
• Complete the full course of antibiotics even if the skin looks better after a few days—this prevents complications and ensures complete bacterial eradication 2

Preventing Spread to Others

Hygiene Measures

• Keep your child's fingernails trimmed short to prevent scratching and spreading infection 1
• Have your child wash hands frequently with soap and water, especially after touching the affected areas 1
• Cover lesions with clean, dry bandages or gauze to prevent direct contact and reduce spread 4
• Do not share towels, washcloths, clothing, or bedding with other family members until treatment is complete 1
• Wash all clothing, towels, and bedding in hot water daily during the first few days of treatment 1

School and Activity Restrictions

• Keep your child home from school, daycare, and organized sports until 24 hours after starting antibiotic treatment 1
• Avoid close contact sports and swimming pools until lesions are healed and no longer draining 1

When to Seek Follow-Up Care

Expected Improvement Timeline

Contact your healthcare provider if the impetigo has not improved within 3-5 days of starting treatment. 5

• You should see new crust formation stop and existing lesions begin to heal within 48-72 hours of starting antibiotics 4
• Most cases resolve completely within 2-3 weeks without scarring 3, 6

Warning Signs Requiring Immediate Attention

• Fever develops or worsens during treatment 1
• Redness spreads beyond the original lesions or becomes more painful 1
• Your child develops decreased urination, blood in urine, or swelling (rare signs of kidney complications) 3
• Severe itching, rash, or irritation develops at the treatment site, which may indicate an allergic reaction 5

Common Pitfalls to Avoid

• Do not stop treatment early even if the skin looks better—incomplete treatment can lead to recurrence and antibiotic resistance 2
• Avoid using only over-the-counter antibiotic ointments like Neosporin, as they are not effective against the bacteria causing impetigo 6
• Do not use topical disinfectants alone (like hydrogen peroxide or alcohol) as primary treatment—they are inferior to antibiotics 3, 7
• Watch for medication side effects: While topical mupirocin has minimal side effects, contact your provider if severe irritation or stinging occurs 5

Managing Discomfort

• Gently remove crusts by soaking them with warm, soapy water before applying medication—this improves antibiotic penetration 1
• Acetaminophen or ibuprofen can be used for any discomfort, though impetigo is typically not painful 1
• Keep the child's environment cool to minimize itching 1

Checking Other Family Members

• Examine siblings and close contacts for new lesions, as impetigo spreads easily within households 1
• If other family members develop lesions, they should be evaluated and treated promptly to prevent ongoing transmission 1