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Impetigo

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Contents

1 Background
2 Clinical Features
3 Differential Diagnosis
- 3.1 Rash
4 Evaluation
5 Management
- 5.1 Antibiotics
  - 5.1.1 Topical therapy
  - 5.1.2 Oral Therapy
6 Disposition
7 See Also
8 References

Background

Superficial epidermal infection characterized by amber crusts (nonbullous) or vesicles (bullous)
May be super-infection or primary infection
- Typical causative organisms are Staphylococcus aureus or Streptococcus pyogenes
Fever and systemic signs are uncommon
Post-streptococcal glomerular nephritis is a possible complication

Impetigo honey-colored scab

Clinical Features

Nonbullous
- Erythematous macules/papules develop into vesicles which become pustular and rupture
  - As rupture release yellow fluid which dries to form stratified golden crust
Bullous
- Bullae form as result of staph toxin
- Some cases caused by MRSA

Differential Diagnosis

Rash

Evaluation

Clinical diagnosis

Management

Antibiotics

Coverage for MSSA, MRSA, Group A Strep

Topical therapy

Mupirocin 2% ointment q8hrs x 5 days
- For nonbullous impetigo, topic antibiotics are as effective as oral antibiotics

Oral Therapy

Cephalexin 500mg (6.25mg/kg) PO q6hrs for 10 days OR
Amoxicillin/Clavulanate 875mg (12.5mg/kg) PO q12hrs daily x 10 days OR
Clindamycin 450mg PO q8hrs daily (or 10mg/kg PO q6hrs) for 10 days OR
Dicloxacillin 500mg (3mg/kg) PO q6hrs daily x 10 days

Disposition

Outpatient

See Also

Rash

References

Authors

Jordan Swartz, Ross Donaldson, Yos Yachivev, Jesse Gentiluomo, Manuel Celedon, Michael Holtz, Kevin Lu, Daniel Ostermayer, Neil Young

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