Peds ID Abx QOTW #5 Answer
Answer: c) Prescribe Clindamycin or Bactrim alone as Staph aureus is more likely the cause
Here’s how others answered
Discussion
First, please note:
- We did notice a mild wording issue in the answer on this question. Answer C should say:
– Prescribe Clindamycin or Bactrim alone as Staph aureus is a possible cause
– ~40% of our Staph aureus is still MRSA; this is why Keflex was not the best choice here
- So those of you who choose Answer B, that was a reasonable choice as many of these infections are GAS
Impetigo management
- Small number of lesions are managed very simply with topical antimicrobials
- Larger number of lesions are often more difficult to manage with topical antibiotics
- Failure with topical antibiotics, or a larger number of lesions = consideration should be given to oral antimicrobials
Which drug to choose?
Topical choices include:
Am Fam Physician. 2014;90(4):229-235
- No Study has been done to determine best
– Retapamulin is more expensive
– OTC meds may be active as well
Oral medications include:
– Keflex (50m/kg) divided BID – no MRSA coverage
- Max dose 500mg po BID
– Clindamycin (30mg/kg) divided TID – MRSA coverage
- Max dose 600mg po TID
– Bactrim (8mg/kg TMP) divided BID – MRSA coverage
- Max dose Bactrim DS po BID
Duration of therapy 5-7 days