A 15-year-old wrestler complains of blisters on his leg. He is afebrile and well-appearing. There are 3 tender pustules about 2 to 3 mm in size surrounded by erythematous areas 1 to 2 inches in size on his right lateral calf. All the pustules yield clear fluid, which you send for culture.
What should be done while awaiting those results?
Answers:
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.
– Learners mistake impetigo for folliculitis and reach for systemic antibiotics.
– Confusion between generic “triple antibiotic” ointments and organism-specific topical therapy.
| 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. |
Localized nonbullous impetigo is best treated with topical mupirocin, avoiding systemic antibiotics when feasible.
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.
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
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
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
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 Med-Challenger Pediatric Medicine Exam Review with CME
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