& Ecthyma (1 of 9)

1 Patient presents w/ lesions that are suggestive of impetigo or ecthyma

2

DIAGNOSIS No ALTERNATIVE Is impetigo or ecthyma DIAGNOSIS confi rmed?

Yes

3

Topical THERAPY DECISION Oral antibiotic Does clinical condition warrant antibiotic use of a topical or oral antibiotic? A A Pharmacological therapy Pharmacological therapy (Topical) 1st-line: • 1st-line: • Fusidic Acid 2nd-line: Any one of the following oral agents: 2nd-line: • Aminopenicillin/beta-lactamase inhibitor • Bacitracin • Cephalosporin (1st generation) • Mupirocin • Cephalosporin (2nd generation) • Retapamulin • Macrolide B Parental education Alternative • Cephalosporin (3rd generation) B Parental education

FOLLOWUP • REVIEW DIAGNOSIS & Improvement after 7-10 days No THERAPY of treatment? • ASSESS COMPLIANCE W/ THERAPY & Yes HYGIENE MEASURES • DO CULTURE & SENSITIVITY - Swab beneath lifted edge of crusted lesion NO FURTHER - TREATMENT NECESSARY Nasal passage swab for • suspected carriers of • Longer treatment may be TREAT BASED ON Staphylococcus aureus needed for ecthyma CULTURE & SENSITIVITY RESULTS © •MIMS NASAL MUPIROCIN FOR S aureus CARRIERS

Not all products are available or approved for above use in all countries. Specifi c prescribing information may be found in the latest MIMS.

B1 © MIMS Pediatrics 2019 IMPETIGO & ECTHYMA • • • Diagnosis Alternative • • • TestsLab • • • • • Ecthyma • • • • • • Impetigo Bullous • • • • • • • Impetigo Nonbullous Presentation Clinical • • • Ecthyma • • • Impetigo Rare: Bullous pemphigoid, foliaceus Bullous pemphigus Rare: syndrome, necrolysis toxic epidermal Non-infectious: Atopiceczema,burns& scalds,contactdermatitis,drugreaction,insectbites,Stevens-Johnson HSV, varicella scabies, , ecthyma, dermatophytosis, , Candidiasis, Infectious: suspected Methicillin-resistant by Saureus (MRSA) caused to be Take bloodcultureswhenpatientappears ill&wheninfectionissevere,recurrent,suspectedtobeanoutbreak,or - cocci positive Gram show ofvesicles stainsmears Gram - Methicillin-resistant Gram stain&/orculturemaybeusedtoconfi rm thediagnosis whentheclinicalpresentationisunclear, grounds ismadeon clinical diagnosis Tests because cases inmost are notnecessary pathogen the butisusuallyasecondary from cultured lesions Saureus istypically GABHS; Etiology: hygiene, malnutrition, heat &highhumidity poor pediculosis, scabies, bites, Insect factors: Predisposing foundonthe legs are typically Lesions w/scarring w/pain&; heals Associated - Ulceration isfrequently adherent covered by crusts - that ulcerated pustules &vesicles become as initiallyappear Lesions Typically occurs inchildren 6mth-18 yr, &inimmunocompromised patients S aureus coagulase-positive by caused Always Etiology: around the diaper area inneonates, extremities; & perineum trunk, multiple, foundonthe are often rapidly face, buttocks, Lesions &are spread, typically symptoms Generally, butmay lymphadenopathy, therehave regional erythema isnosurrounding pain orsystemic a thin light crust brown varnish-like Bullae ruptureeasily&amoistred-surfacederosionappearssurroundedby“collarette”ofscale,whichthenforms that contain yellow serous fluid that vesicles into turn as fl onintact develop skin&begin typically cm indiameter) (0.5-3 Lesions accid bullae &youngchildren Typically newborns occurs ininfants, streptococci (GABHS) Abeta-hemolytic aureus &group Staphylococcus Etiology: orburns simplex), scabies (chicken herpes infections viral pox, wounds, bites, insect climate, Poor hygiene, inthe interruption ofthe lesions aff warm skinby factors: Predisposing eg area, ected Lesions aretypicallyfoundonexposedareasoftheface(esparoundnose&mouth)extremities 50%ofpatients About have leucocytosis - Occasionally, patients may suff adenopathy orpain&usuallyhaveer pruritus local crusts Purulent “honey-colored” discharge &forms dries -  quickly evesicles 4-6days over pustulate anerosion orclusters leaving oferosion &rupture easily - rings orpapules that that w/macules Initially presents smallvesicles quickly may become have infl narrow ammatory commonlyMost occurs inchildren ofage 2-5yr contagiosa orimpetigo impetigo crusted as known common also Most ofimpetigo; form confi infection rm to isrecommended pus/crust stainingfrom presentation, clinical madeby gram butdirect be can Diagnosis orasuperinfection denovo aninfection May be margins violaceous ulcers &elevated “Punched-out” w/yellow crust - ulcerated that ofimpetigo form extends totheDeeply dermis inpatients esp 2-6yr aged Complication: ofglomerulonephritis Risk in~14days w/otreatment w/oscarring spontaneously resolve cases Most superfi contagious, A very contact inclose amongpeople spreads that skininfection cial, bacterial easily

©are suspected the causative agentsCulture reveal test &the appropriate &sensitivity therapy when resistant esp organisms MIMS (MRSA) is suspected orifthe patient fi fails issuspected S aureus (MRSA) rst treatment 1 Impetigo &Ecthyma(2of9) IMPETIGO &ECTHYMA IMPETIGO 2 DIAGNOSIS B2 © MIMS Pediatrics 2019 IMPETIGO & ECTHYMA • • • • Retapamulin • • Mupirocin • • Bacitracin TopicalOther Antibiotics • • • Fusidic Acid • • Topical Antibiotics • • • Goals • Referral • • Others • • Antibiotic Oral erapy • • Topical Antibiotic erapy • - Eff ects: Suitable alternative toFusidic acid cost ofits a2ndlinetreatment as Considered because agentNew treatment fortreating w/ashort impetigo duration ofonly5days ofSaureus intheir w/mupirocin are nares ointment treated Carriers nasally applied - fortreatment sideeff &Cefalexin fewer &produces ofimpetigo Erythromycin than oralagents ects Eff ects: Eff ects: impetigo therapy topical formany forlocalized as Used years Active staphylococci against &streptococci (including MRSA) - Eff ects: nonbullouslesions forlocalized Recommended 1st-line antibiotic topical ofcontact to2wkduerisk &antibiotic limited sensitization resistanceUse shouldbe development the isnotrecommended ofhealing during process ofscabs Removal - cloth w/awet compress crusts takingabath orby Soften w/soap orshower - toenhance removal crust penetration after applied Must be Prevent recurrence Prevent contagious spread &reduce the the symptoms Relieve duration ofinfection Recurrence isfrequent - setting care therapy inprimary tomaximal orunresponsive isextensive, severe, Infection - isunclear Diagnosis - considered may ordermatologist when: be A referral toapediatrician eff its regarding skinreactions tocause atendency &ithas ectiveness Topical (eg antiseptics Hydrogen are isatreatment peroxide cream) available evidence optionbutlimited communicable &maygeneralized become since lesions untreated ishighly impetigo forlocalized aloneare even notrecommended Hygiene measures ecthyma forwidespread Parenteral antibiotics needed may be etc), orinimmunocompromised, unable recurrent those totolerate infection antibiotics topical culosis, involvement where there ofdeep patients ecthyma , isevidence (eg incases furun- cellulitis, the near mouth, lesions nonbullousimpetigo, widespread treatmentPreferred lesions, inpatients w/widespread impetigo) ofinvolvement totreat orsmallareas singlelesions Used (localized theantibiotics near mouth) ifapplied away the from mouth located (child nonbullousimpetigo may appropriateMay lick be inlocalized topical - oftreatmentDuration according istailored improvement toclinical

data show activity against Methicillin-resistant against In data activity staphylococci show vitro & streptococci 2nd-lineoftreatment as FusidicConsidered after staphylococci itisactiveagainst acid,as (including MRSA) whilewaitingfortheC&Sresults days If unresponsiveordeteriorating,itisreasonabletoextendbeyond7 Has been proven to be as eff as proven tobe been Has Fusidic Ampicillin, oralantibiotics eg as Dicloxacillin,ective acid&several Active Saureus against &streptococci © eff tobe shown been Has Astreptococci Saureus against andgroup ective MIMS eff clinically as proven tobe been Has &oralantibiotics Mupirocin as ective Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing A PHARMACOLOGICAL THERAPY Impetigo &Ecthyma(3of9) 3 THERAPY DECISION B3 © MIMS Pediatrics 2019 IMPETIGO & ECTHYMA • • Prevention • • • • • • • • • • Tetracyclines • Linezolid • Clindamycin • Co-trimoxazole Antibiotics Oral Other • • • Macrolides • (3rdGeneration) Cephalosporins • (2ndGeneration) Cephalosporins • • (1stGeneration) Cephalosporins • • Penicillins Antistaphylococcal • Antibiotics Oral Use of insect repellant to prevent insect bites repellant toprevent insect Use ofinsect Prompt attention them antibiotic topical &applying clean keeping tominorwoundseg ifcondition therapyifcondition didnotimprove starting 7days worsened child orsooner after forfollow-up Return Improve nutritional status &treat underlying conditions the child’sKeep fi &toavoidngernails short scratching the lesions soap &water oftheDaily cleaning w/antiseptic may lesions prevent recurrence at distant sites dailybaths) contact persons, Practice handsafter simple (eg w/infected cleanliness washing antibiotic treatment Child must until todaycare notreturn oruntil there orschool crusting 48 isnofurther initiation of hr after etc sheets, To prevent contagious patient spread, &avoid shouldavoid oftowels, sharing contact persons w/noninfected inchildrenContraindicated ≤8yr considered infections May formildtomoderate MRSA be Doxycycline Eg Minocycline, Good choiceformildtomoderatebullousimpetigoinpatientsfromcommunities w/ highMRSAresistance strain Erythromycin-resistant by caused infections high-inoculum Good choiceforsusceptibleMRSAinfections;however,thereisapotentialdevelopmentofresistancew/ community-acquired against activity butnottostreptococci MRSA good very Has notcover MRSA Does - Typically considered treatment inthe resistance community ofchoice is widespread Erythromycin unless - Erythromycin - Eg Clarithromycin, Azithromycin, Roxithromycin Alternative forPenicillin-allergic patients - coverageGram-negative Variable &noinherent MSSA organisms esp advantage tothe broader intheir Gram-positive against activity Eg Cefaclor, Cefuroxime Cefprozil, notcover MRSA Does &isgenerally well-tolerated &Spyogenes Excellent activityagainstMethicillin-susceptibleSaureus (MSSA) Staphylococcus by caused aureus tissueinfection (MSSA) andother forImpetigo skinandsoft Indicated - Amoxicillin +Clavulanate notcover MRSA Does - Very eff tolerated compared butless toCefalexin ective - toinitiate therapy used when May staphylococcal be issuspected infection - staphylococci penicillinase-producing For by caused infections - Eg Dicloxacillin &Flucloxacillin Choice ofagentwilldependonsuspectedorganism,localresistancepatterns,cost&productavailability

© MIMSto Erythromycin ininstances esp ofintolerance advantageous cure ratesMay superior butdonotprovide be toErythromycin, pressure foremergence selective tends toexert ofactivity anincreased ofantibiotic resistance Broad spectrum Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not A Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing PHARMACOLOGICAL THERAPY (CONT’D) B Impetigo &Ecthyma(4of9) PARENTAL EDUCATION B4 © MIMS Pediatrics 2019 IMPETIGO & ECTHYMA (TM)) Trimethoprim & (SMZ) (Sulfamethoxazole Co-trimoxazole 15mg/kg/day IM/IV Kanamycin Drug Drug All dosage recommendations are for children w/ normal renal & hepatic function unless otherwise stated. otherwise unless function &hepatic renal w/ normal children for are recommendations dosage All Products listed above may not be mentioned in the disease management chart but have been been have but chart management disease the in mentioned be not may above listed Products placed here based on indications listed in regional manufacturers’ product information. product manufacturers’ regional in listed indications on based here placed

© MIMS doses 2-4 divided in 1.5g/day IM/IV dose: Max 480 mg PO 12hrly 480mgPO 6-12 yr: 12hrly 240mgPO 6 mth-5 yr: 6 wk-5 12hrly mth: 120mgPO Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing ANTIBACTERIAL COMBINATIONS Dosage Dosage Impetigo &Ecthyma(5of9) Dosage Guidelines AMINOGLYCOSIDE B5 • • • • Instructions Special • Reactions Adverse • • • Instructions Special • Reactions Adverse aminoglycosides in patientsContraindicated to w/allergy lactation impairment & nutrition, inpregnancy & poor Use w/caution inthe elderly, patients w/renal 7-10 days oftreatmentDuration within shouldbe 30-60minutes over 0.25-0.5% solution ofa aninfusion as given shouldbe dose IV Kdefi B&vit vit diarrhea, ciency Nephrotoxicity, rarely shock, ototoxicity; dysfunction deficiency, hepatic/renal impairment &thyroid G6PDdefidisorders, ciency, potential folate Use w/ caution inpatients w/hematological <4 wkold insuffi ciency, anemia &ininfants megaloblastic renal/hepatic severe sulfonamides, in patientsContraindicated allergic to Maintain adequate fluid intake the urine) Urogenital syndrome); eff in (crystallization ect life-threatening (eg Stevens-Johnson range mild(eg tosevere/ from can rash) reactions Hypersensitivity photosensitivity); GI eff (N/V,ects diarrhea); anorexia, Dermatologic effDermatologic pruritus, (rash, ects Remarks Remarks © MIMS Pediatrics 2019 IMPETIGO & ECTHYMA 1 Combination w/ other emollients is available. Please see theCombination forspecifi w/other latest MIMS emollients see isavailable. Please information. c prescribing Cefadroxil 30 mg/kg/day PO divided 12hrly divided 30mg/kg/day PO Cefadroxil First Generation Cefpodoxime 8-10 mg/kg/day PO divided 12hrly divided 8-10mg/kg/day PO Cefpodoxime 24hrly 14mg/kg/day ordivided PO Cefditoren Cefdinir  Generation ird 12-24hrly 20mg/kg/day PO Cefuroxime Cefprozil Cefaclor 6hrly divided 25-50mg/kg/day PO Generation Second Cefradine Cefalexin rcoa Bar Triclosan Zinc oxide Zinc Drug Drug All dosage recommendations are for children w/ normal renal & hepatic function unless otherwise stated. otherwise unless function &hepatic renal w/ normal children for are recommendations dosage All 1 Products listed above may not be mentioned in the disease management chart but have been been have but chart management disease the in mentioned be not may above listed Products placed here based on indications listed in regional manufacturers’ product information. product manufacturers’ regional in listed indications on based here placed 100 mg PO 8hrly 100mgPO >20 kg: 8hrly 50mgPO >10-20 kg: 6-10 kg: Fine granules Max dose:600mg/day 12 hrly Max dose:250mg/day 12hrly divided PO 12hrly or20mg/kg/day 125mgPO >2 yr: 24hrly Max dose:500mgPO 8hrly 250mgPO >5 yr: 8hrly 125mgPO 1-5 yr: 8hrly 62.5mgPO <1 yr: 1g/day dose: Max 8 hrly divided >1 mth:20-40mg/kg/day PO 6-12hrly divided 25-50 mg/kg/day PO Oint Available © MIMSStrength EMOLLIENTS, CLEANSERS&SKINPROTECTIVES Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not 50 mg PO 12hrly 50mgPO Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing Dosage • • Impetigo &Ecthyma(6of9) adjunct skincleanser Mild antibacterial & damaged skin damaged of helps inhealing & protects, Soothes, Dosage Guidelines CEPHALOSPORINS Indication B6 • • • • Instructions Special • • • Reactions Adverse • • Treat for7-10days of colitis w/history esp impairment &GIdisease &patients w/renal sensitivity; cross Penicillin, there 10%chance may be of Use w/caution inpatients allergic to syndrome w/gasping associated been has this as benzoate w/caution inneonates containingUse suspension sodium distress gastric todecrease taken w/food May be cephalosporins sidechain containing(NMTT) frequentlymost w/N-methylthiotetrazole &occurs reported have been bleeding) hypoprothrombinemia (w/orw/o &/or time(APTT), thromboplastin partial activated prolonged prothrombinProlonged time(PT), eff have occurred ects hepatic &renalRarely hematologic, eff (encephalopathy,ects convulsions); w/CNS associated may be High doses Other eff infections) (Candidal ect diarrhea/colitis); antibiotic-associated N/V,(diarrhea, rarely occur); GIeff can anaphylaxis ects eg reactions severe rash, pruritus, (urticaria, reactions Hypersensitivity Wash required as Apply needed 12-24hrly oras Administration Remarks © MIMS Pediatrics 2019 IMPETIGO & ECTHYMA Lincomycin Clindamycin Clarithromycin Azithromycin Macrolides Advanced 6-8hrly divided 30mg/kg/day PO Roxithromycin Midecamycin Erythromycin Drug Drug All dosage recommendations are for children w/ normal renal & hepatic function unless otherwise stated. otherwise unless function &hepatic renal w/ normal children for are recommendations dosage All Products listed above may not be mentioned in the disease management chart but have been been have but chart management disease the in mentioned be not may above listed Products placed here based on indications listed in regional manufacturers’ product information. product manufacturers’ regional in listed indications on based here placed 8 hrly : 37.5mgPO ≤10 kg 6-8 hrly divided PO 8-25 mg/kg/day >1 mth: 12hrly x5-10days 7.5 mg/kgPO 24hrly x3day 400mgPO 36-45 kg: 24hrly x3day 300mgPO 26-35 kg: 24hrly x3day 200mgPO 15-25 kg: 24hrly10 mg/kg/day x3days PO >6 mth: 12hrly divided 5-8 mg/kg/day PO 6-40 kg: 6-12hrly divided 30-50 mg/kg/day PO © 6-8hrly divided 60 mg/kg/day PO >1 mth: infections: More severe 6-8hrly divided mg/kg/day30 PO >1 mth: infections: Serious MIMS Dosage Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing Dosage Impetigo &Ecthyma(7of9) Dosage Guidelines OTHER ANTIBIOTICS • • • • Instructions Special • Reactions Adverse • • • Instructions Special • • Reactions Adverse Monitor liver & kidney function w/ prolonged therapy w/prolonged function Monitor liver &kidney Contraindicated inpatientsallergictoLincomycin, &innewborns &asthma ofGIdisease Use w/caution inpatients w/history oralintakeafter ofLincomycin Taken ofwater onanempty w/aglass stomach & 1-2hrbefore (LFTs), tests [abnormal liver function renal dysfunction] effCV administration); Other eff IV afast after (hypotension ect ects eff Dermatologic edema); angioneurotic urticaria); (skinrashes, ects eff Hypersensitivity purpura); thrombocytopenic (anaphylaxis, ects Hematologic eff agranulocytosis, neutropenia, (leukopenia, ects GI eff (N/V,ects esophagitis); discomfort, abdominal diarrhea, Discontinue occurs ifdiarrhea syndrome w/gasping associated been this has as neonates in Use Clindamycin-containingsodiumbenzoateproductsw/caution in atopic patients &inpatients w/renal orhepatic impairment ofcolitis, w/history esp Use w/ caution inpatients w/GIdisease Other effoccurred; (polyarthritis) ect dermatitis); Hematologicvesiculobullous &hepatic eff have ects effDermatologic multiforme, exfoliative (erythema & ects rarely anaphylaxis) urticaria, (rash, reactions N/V,colitis, Hypersensitivity taste); pain,metallic abdominal GI eff ects (diarrhea, severeantibiotic-relatedpseudo-membranous MACROLIDES B7 • • Instructions Special • • • • Reactions Adverse dysfunction Use w/caution inpatients w/hepatic distress gastric todecrease May take w/food discoloration, dysgeusia Clarithromycin may cause &tongue tooth Erythromycin than less GIdisturbances &ClarithromycinAzithromycin tend tocause macrolides w/some occurred have loss tinnitus/hearing Dose-related Rarely cardiotoxicity, hepatotoxicity; rarely rash, anaphylaxis); pruritus, (urticaria, are reactions uncommon Hypersensitivity headache) Otherstenosis); eff infections, (Candidal ects pyloric infantile hypertrophic stomatitis, diarrhea/colitis, antibiotic-associated &other diarrhea GIdisturbances, GI eff (N/V,ects discomfort, abdominal Remarks Remarks © MIMS Pediatrics 2019 IMPETIGO & ECTHYMA Oxacillin Flucloxacillin Dicloxacillin Cloxacillin Penicillins Antistaphylococcal Linezolid clavulanate) Amoxicillin/ (Co-amoxiclav, clavulanic acid Amoxicillin/ Inhibitors w/ Beta-lactamase Aminopenicillins sulbactam) Ampicillin/ of Pro-drug (Sultamicillin: sulbactam Ampicillin/ Drug Drug All dosage recommendations are for children w/ normal renal & hepatic function unless otherwise stated. otherwise unless function &hepatic renal w/ normal children for are recommendations dosage All Products listed above may not be mentioned in the disease management chart but have been been have but chart management disease the in mentioned be not may above listed Products placed here based on indications listed in regional manufacturers’ product information. product manufacturers’ regional in listed indications on based here placed © MIMS divided dose or6hrly dose divided in 50-100mg/kg/day<40 kg: PO 6hrly 125mgPO 2-10 yr: 6hrly 62.5mgPO <2 yr: hrly POdivided6 mg/kg/day 12.5-25 6hrly divided 50-100 mg/kg/day PO 12hrly 375-750mgPO >30 kg: 12 hrly divided 25-50mg/kg/day<30 kg: PO x 10-14days 12hrly 600mgPO 12-18 yr: x 10-14days 12hrly 10mg/kgPO 5-11 yr: 10-14 days 8hrly x 10mg/kgPO <5 yr: 8 hrly at 7th day oflife mg/kg PO to10 May increase 12hrly 10mg/kgPO AOG): (<34wks neonates Preterm 25 mg/kg/day PO divided 8hrly divided 25mg/kg/day PO <12 yr: 8hrly 312.5mgPO kg: >6 yr/18-40 8hrly 156.25mgPO kg: 1-6 yr/10-18 25mg/kg/day PO <1 yr: Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing Dosage OTHER ANTIBIOTICS (CONT’D) OTHER ANTIBIOTICS Impetigo &Ecthyma(8of9) Dosage Dosage Guidelines PENICILLINS B8 • • Instructions Special • Reactions Adverse wkly &platelet counts ofCBC Recommend monitoring dysfunction myelosuppression renal &inpatients w/severe Use w/caution inpatients w/preexisting abnormal LFTs) infection, (moniliasis Other eff thrombocytopenia); pancytopenia, ects anemia, myelosuppression including leucopenia, Hematologic effdizziness); (reversible ects eff occur); CNS can insomnia, (headache, ects constipation, diarrhea/colitis antibiotic-associated GI eff N/V, (diarrhea, ects taste, metallic • • Instructions Special • • Reactions Adverse impairment Use w/ caution inpatients w/renal Avoid inpatients w/Penicillin allergy convulsions) effw/ CNS (encephalopathy,ects eff associated may be Highdoses ects; renalRarely &hepatic hematologic, Other eff infections) (Candidal ect diarrhea/colitis); antibiotic-associated N/V,(diarrhea, rarely occur); GIeff can anaphylaxis ects eg reactions severe pruritus, urticaria, (rash, reactions Hypersensitivity Remarks Remarks © MIMS Pediatrics 2019 IMPETIGO & ECTHYMA 1 Available w/ other drug combinations. Please see the forspecifiAvailable latest MIMS see Please w/ other combinations. drug c formulations. aircnVarious strengths & Bacitracin Chloramphenicol Doxycycline uii cd2%Fusidic acid Fusidic acid Tetracycline Minocycline Gentamicin 0.1% cream, oint 0.1%cream, Gentamicin Mupirocin 2% cream, oint, oint, 2%cream, Mupirocin emcnVarious strengths & Neomycin eaaui 1%oint Retapamulin Drug Drug All dosage recommendations are for children w/ normal renal & hepatic function unless otherwise stated. otherwise unless function &hepatic renal w/ normal children for are recommendations dosage All Products listed above may not be mentioned in the disease management chart but have been been have but chart management disease the in mentioned be not may above listed Products placed here based on indications listed in regional manufacturers’ product information. product manufacturers’ regional in listed indications on based here placed available combinations are 2g/day dose: Max 6hrly PO 250-500mg >12 yr: 3% oint oint2% cream, 24 hrly 2mg/kg by followed 12hrly divided 4mg/kgPO >8 yr: 2% Na fusidate oint2% Nafusidate cream 24 hrly 2mg/kg by followed 12hrly divided 4mg/kgPO >8 yr: 0.3% cream nasal oint nasal ©available combinations are MIMS Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not Available Strength Dosage Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing Please see the end of this section for the reference list. reference the for section this of end the see Please Impetigo &Ecthyma(9of9) TOPICAL ANTIBIOTICS Dosage Guidelines TETRACYCLINES Apply 8-24hrly Apply 6-8hrly • • • Instructions Special • • Reactions Adverse Apply 8-12hrly Apply 6-8hrly Apply 8-12hrly carriage: of nasal For elimination Apply 8hrly Apply 6-24hrly 5 days Apply 12hrly x Use w/caution inrenal orhepatic impairment Avoid in patients &inpatients ≤8yr w/SLE Take w/plenty offluid whilesitting orstanding&well before - Avoid tosunlight ortanningbeds longexposure have reactions occurred hypersensitivity intracranial disturbances; pressure &visual w/headache hepatotoxicity,Rarely renal dysfunction, hematologic eff ects, infants) discoloration interference inyoung ofteeth, growth w/bone eff effOther (photosensitivity); ect infections, (Candidal ects when taken w/aninsufficient amount Dermatologic ofliquid); ulceration esophageal occurred has dysphagia, occurred, has GI eff (N/V,ects diarrhea/colitis antibiotic-associated diarrhea,

retiring tobed retiring Dosage B9 • Reactions Adverse • Reactions Adverse • Precautions Special • Reactions Adverse • Reactions Adverse • Instructions Special • Reactions Adverse • Reactions Adverse • Reactions Adverse Hypersensitivity skinreactions Hypersensitivity Allergic reactions, superinfections Allergic reactions, Discontinue occurs ifsensitivity irritation mildstinging, Rash, Erythema, pruritus Erythema, to severe renal impairmentto severe Use w/ caution inpatients w/moderate mucosa exudate, nasal reactions increased tenderness, stinging, burning, swelling, skin, dry erythema, rash, Pruritus, Itching, burning, blistering, peeling blistering, burning, Itching, irritation, erythema, contact dermatitis irritation, erythema,contactdermatitis application site diarrhea, eczema, pain, pruritus, pyrexia, Headache, 1 Remarks Remarks © MIMS Pediatrics 2019