How to Apply Topical Fusidic Acid (Fucidin) for Impetigo in Children Over 2 Months
While fusidic acid is effective for impetigo, mupirocin 2% ointment applied three times daily for 5-7 days is the preferred first-line topical treatment recommended by the Infectious Diseases Society of America for children with impetigo. 1, 2
Application Technique for Fusidic Acid
If fusidic acid is being used, follow this protocol:
Pre-Application Preparation
- Gently wash the affected area with soap and water before each application to remove crusts and debris, which enhances antibiotic penetration 3
- Soak honey-colored crusts with warm, soapy water to soften them prior to medication application 3
- Pat the area dry with a clean towel
Application Protocol
- Apply fusidic acid 2% cream or ointment to the affected lesions three times daily 4, 5
- Use the cream formulation for weeping or moist lesions that do not require a dressing 5
- Use the ointment formulation for dry lesions or when applying a dressing over the area 5
- Continue treatment for 5-7 days 2, 6
- Cover treated lesions with clean, dry bandages when possible to prevent spread to others 1, 6
Key Advantages of Fusidic Acid
- Fusidic acid penetrates deeply into skin layers, reaching high antimicrobial concentrations even in damaged epidermis 7
- It demonstrates potent activity against Staphylococcus aureus (including methicillin-resistant strains) and Streptococcus pyogenes, the primary pathogens in impetigo 4, 7
- The medication has a low risk of contact sensitization due to its large steric structure 7
When to Escalate Treatment
Switch to oral antibiotics if:
- No improvement occurs after 48-72 hours of topical therapy 2, 6
- The impetigo is extensive (multiple lesions or >100 cm² total area) 3, 6
- Systemic symptoms develop (fever, spreading redness, increasing pain) 2, 3
- Topical application is impractical due to lesion location or extent 6
Oral antibiotic options include: cephalexin, dicloxacillin, or clindamycin for 5-10 days 1, 3, 6
Critical Infection Control Measures
- Keep the child home from school/daycare for at least 24 hours after starting antibiotic treatment 3
- Trim fingernails short to reduce scratching and transmission 3
- Do not share towels, washcloths, clothing, or bedding until treatment is complete 3
- Wash all linens in hot water daily during the first few days of therapy 3
- Examine siblings and close contacts for new lesions, as impetigo spreads easily within households 3
Common Pitfall
Caution: Emerging fusidic acid resistance has been documented with repeated or prolonged use, with resistance rates increasing from 8% to 58% in one study of eczema patients 8. This reinforces why mupirocin remains the guideline-recommended first-line agent for impetigo 1, 2.