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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

Q5 graph

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:

Q5 impetigo abx

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