Impetigo — RACGP Fellowship MCQ

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A 34‑year‑old woman presents with honey‑coloured crusted lesions around the nose after her child had a similar rash. She is well and afebrile. There are four small localised lesions and no cellulitis. What is the most appropriate management?

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Correct answer: E — Topical mupirocin or antiseptic treatment with hygiene advice

Explanation lettering: E = shown as A · D = shown as B · A = shown as C · C = shown as D · B = shown as E

This patient has mild, localised non‑bullous impetigo (four crusted lesions, no systemic signs). Australian Therapeutic Guidelines recommend topical mupirocin applied 8‑hourly for 5 days as first‑line treatment in such cases, alongside hygiene advice (e.g., gentle washing of crusts) ([ccmsfiles.tg.org.au](https://ccmsfiles.tg.org.au/s4/PDFs/GPSummary_v18.pdf?utm_source=openai)). Oral flucloxacillin (Option A) is reserved for more extensive disease (multiple lesions or systemic involvement) ([australianprescriber.tg.org.au](https://australianprescriber.tg.org.au/articles/bacterial-skin-and-soft-tissue-infections.html?utm_source=openai)). Routine swabbing (C) is unnecessary in straightforward cases. Topical aciclovir (D) treats viral infection (e.g., herpes simplex), not bacterial impetigo. Impetigo is bacterial, not viral (E), and does require treatment to limit spread and complications.

Reference: Therapeutic Guidelines: ‘Antibiotic prescribing in primary care summary table’ for impetigo (2023, amended 2024), plus Australian Prescriber article ‘Bacterial skin and soft tissue infections’ (2016), https://ccmsfiles.tg.org.au/s4/PDFs/GPSummary_v18.pdf