Impetigo is a superficial skin infection that is seen most commonly in children. Most common during hot, humid weather, which facilitates microbial colonization of the skin. Minor trauma, such as scratches or insect bites, allows entry of organisms into the superficial layers of skin, and infection ensues. The infection is generally classified as bullous or non-bullous based on clinical presentation.

AETIOLOGY

Most cases of impetigo were caused by S. pyogenes, but recently S. aureus, either alone or in combination with S. pyogenes, has emerged as the principal cause of impetigo. So, the bullous form is caused by strains of S. aureus capable of producing exfoliative toxins.

PRESENTATION

Exposed skin, especially the face, is the most common site.

SIGNS & SYMPTOMS

Nonbullous impetigo indeed manifests initially as small, fluid-filled vesicles. Moreover, Purulent discharge from the lesions dries to form golden yellow crusts that are characteristic of impetigo In the bullous form of impetigo, the lesions begin as vesicles and turn into bullae containing clear yellow fluid. Bullae soon rupture, forming thin, light brown crusts. As a result, regional lymph nodes may be enlarged. Pruritus is common, and scratching of the lesions may further spread infection through excoriation of the skin. In general, Weakness, fever, and diarrhoea sometimes are seen with bullous impetigo

DIAGNOSIS

Crusted tops of lesions should be raised so that purulent material at the base of the lesion can be cultured. A complete blood count is often performed because leukocytosis is common.

TREATMENT

Although impetigo may resolve spontaneously, antimicrobial treatment is indicated to relieve symptoms, prevent the formation of new lesions, and prevent complications, such as cellulitis. Penicillinase- resistant penicillins are preferred for treatment because of the increased incidence of infections caused by S. aureus. On the whole, Penicillin, administered as a single intramuscular dose of benzathine penicillin G (300,000 to 600,000 units in children, 1.2 million units in adults) or as oral penicillin VK, is effective for infections known to be caused by S. pyogenes. So, penicillin-allergic patients can be treated with clindamycin. Additionally, the duration of therapy is 7 to 10 days. Moreover, topical therapy with mupirocin ointment (applied three times daily for 7 days) is as effective as erythromycin. Removal of crusts by soaking in soap and warm water also may be helpful in providing symptomatic relief.

Oral Agents

NAMEDOSEFREQUENCY
Amoxicillin Clavulanate875 mgBD
Cefadroxil250 – 500 mgBD
Cephalexin250 – 500 mgQID
Ciprofloxacin500 – 750 mgBD
Clindamycin300 – 600 mgTID/QID
Dicloxacillin250 – 500 mgQID
Doxycycline100 – 200 mgBD
Erythromycin250 – 500 mgQID
Levofloxacin500 – 750 mgOD
Metronidazole250 – 500 mgTID
Penicillin VK250 – 500 mgQID

Parenteral Agents

NAMEDOSEROAFREQUENCY
Ampicillin1 – 2 gmIVQID
Cefazolin1 gmIVQID
Cefepime1 – 2 gmIVBD
Cefotaxime1 – 2 gmIVTID
Ceftriaxone1 gmIVOD
Ciprofloxacin400 mgIVBD
Clindamycin300 – 600 mgIVTID

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