The correct answer is #2, mupirocin. There’s no particular question trick at play here, except the tendency to grab non-specific antibiotics. 🙂
The author of the question (or the learning objectives of the question) want you to focus in on the small number of superficial pustules, the localized non-systemic infection. The question stem suggests a contact sport, raising skin-to-skin infection risk.
Why This Question Is Often Missed
– Learners mistake impetigo for folliculitis and reach for systemic antibiotics.
– Confusion between generic “triple antibiotic” ointments and organism-specific topical therapy.
What the Distractors Indicate
| Option | What It Tests / Implies | Why It’s Wrong Here |
|---|---|---|
| Start amoxicillin. | Assumes a narrow-spectrum penicillin will cover strep/staph. | Fails to cover MRSA and isn’t recommended for localized impetigo; systemic therapy not first-line. |
| Apply triple antibiotic ointment. | Relies on broad-spectrum topical neomycin/polymyxin/bacitracin. | Poor activity against common impetigo pathogens and higher risk of contact dermatitis. |
| Start trimethoprim/sulfamethoxazole. | Targets MRSA systemically. | Systemic therapy is unnecessary for a few localized lesions when topical mupirocin suffices. |
| Apply miconazole ointment. | Tests for fungal etiologies (tinea). | Impetigo is bacterial; antifungal therapy is ineffective. |
High-Yield Pearl
Localized nonbullous impetigo is best treated with topical mupirocin, avoiding systemic antibiotics when feasible.
Core Learning Objectives
The “Test Trick” at Play
This item plays on the examinee’s tendency to overuse systemic or non–impetigo-specific therapies. By including plausible but suboptimal topical agents (triple antibiotic, antifungal) and systemic antibiotics, it tests whether you recall that impetigo guidelines favor organism-directed, topical mupirocin for limited disease.
Additional Practice Questions and Remediation
Question 1
A 9-year-old boy presents with three honey-crusted lesions around his nostrils for 2 days. He is well-appearing and afebrile. What is your next step?
A. Apply mupirocin 2% ointment
B. Start oral cephalexin
C. Apply clotrimazole cream
D. Start oral doxycycline
Question 2
A 17-year-old basketball player has two small pustules with erythematous halos on his forearm. Cultures are pending. You start:
A. Oral clindamycin
B. Topical mupirocin
C. Triple antibiotic ointment
D. Topical ketoconazole
Question 3
A 12-year-old girl developed four papulovesicular lesions on her chin with clear fluid. She feels well. Culture is pending. Management:
A. Apply mupirocin 2% ointment
B. Start amoxicillin-clavulanate
C. Apply petroleum jelly only
D. Start oral azithromycin
Mini Case Discussion Prompt
Compare and contrast the management of localized nonbullous impetigo versus extensive or bullous impetigo: when do you transition from topical to systemic therapy, and what agents do you choose?
This question appears in one of our Med-Challenger Pediatric Emergency Medicine Review with CME courses based directly on PEMQBook texts.
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