Impetigo — SCE Dermatology MCQ

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EasyCutaneous InfectionImpetigoSCE Dermatology

A 4-year-old boy presents with honey-coloured crusted lesions on his face around the nose and mouth. There are satellite lesions developing peripherally. He is afebrile and systemically well. What is the most appropriate first-line treatment?

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Correct answer: E — Oral flucloxacillin

For non-bullous impetigo that is extensive (multiple sites, spreading lesions), NICE guidelines recommend oral flucloxacillin as first-line treatment. Topical fusidic acid or mupirocin is appropriate for localised impetigo (few lesions, one area), but the spreading satellite lesions suggest more extensive disease requiring oral therapy. Fusidic acid resistance is increasing in the UK and should be used topically for no more than 2 weeks. IV antibiotics are unnecessary in a systemically well child.

Reference: NICE 2020 CKS Impetigo; BAD 2021 Skin Infection Guidelines