Impetigo in Children: Adjunctive Care and Non-Antibiotic Measures

Impetigo Management: Antibiotics + Supportive Care

Impetigo (usually S. aureus, sometimes strep) requires antibiotics (topical mupirocin/retapamulin for limited; oral cephalexin/clamoxicillin for extensive). Adjunctive measures improve comfort and limit spread.

Adjunctive Care

1. Gentle cleansing: Warm water, mild fragrance-free cleanser. Remove crusts with soak (saline/Burow's) – don't pick. Pat dry.
2. Topical antibiotic application: After cleaning, thin layer, cover if draining.
3. Occlusion? Non-occlusive preferred (air promotes healing); occlusive if scratching risk.
4. Itch control: Oral antihistamine (cetirizine), cool compresses, trim nails.
5. Bleach baths (dilute): ¼ cup 6% bleach/full tub (40 gal) 2x/week – reduces staph colonization. Rinse after.
6. Decolonization (recurrent): Intranasal mupirocin 5d/mo + bleach baths + chlorhexidine washes.

Infection Control

• Separate towels, linens, clothing; hot wash/dry.
• No sharing razors, toys, sports gear.
• Cover lesions (clothing, bandage) in group settings.
• Exclude from school/daycare until 24h on antibiotics + lesions covered.

What NOT to Do

• Harsh soaps, alcohol, hydrogen peroxide – damage tissue, delay healing.
• Topical steroids alone – worsens infection.
• Oral antibiotics for localized non-bullous (topical non-inferior).

Follow-Up

• Re-evaluate if no improvement in 48-72h on antibiotics.
• Consider MRSA if failure (culture, switch to clindamycin/TMP-SMX/doxycycline).
• Recurrent → evaluate household contacts, nasal carriage, immune workup.