11.21 Impetigo
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agk's Library of Common Simple Emergencies

Presentation
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Parents will usually bring their children in 
because they are developing unsightly skin 
lesions, which may be pruritic and are found most 
often on the face or other exposed areas. 
Streptococcal lesions consist of irregular or 
somewhat circular, red, oozing erosions, often 
covered with a yellow- brown crust. These may be 
surrounded by smaller erythematous macular or 
vesiculopustular areas. Staphylococcal lesions 
present as bullae which are quickly replaced by a 
thin shiny crust over an erythematous base.

What to do:
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- Prescribe mupiricin 2% ointment (Bactroban) to 
    the rash tid for 3-5 days. Have parents 
    soften and cleanse crusts with warm soapy 
    compresses before applying the antibiotic 
    ointment.
- For severe or resistant cases, add a 10 day 
    course of erythromycin or penicillin VK 
    (250mg qid), or one intramuscular injection 
    of benzathine penicillin (600,000 units im 
    for children 6 years and younger, 1.2 million 
    units im for children over 7 years.) For 
    suspected staphylococcal infections use 
    dicloxacillin (250mg qid) in place of 
    penicillin (or prescribe erythromycin or 
    cefadroxil).

What not to do:
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- Do not routinely culture these lesions. This is 
    only indicated for unusual lesions or lesions 
    that fail to respond to routine therapy.

Discussion
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Impetigo is usually self-limiting and it is 
believed that antibiotic treatment does not alter 
the subsequent incidence of secondary 
glomerulonephritis. Impetigo is very contagious 
among infants and young children and may be 
associated with poor hygiene or predisposing skin 
eruptions such as chicken pox, scabies, and 
atopic and contact dermatitis.

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 from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
 Longwood Information LLC 4822 Quebec St NW Wash DC
 1.202.237.0971 fax 1.202.244.8393 electra@clark.net
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