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| IMPETIGO
| | {| style="border: 0px; font-size: 90%; margin: 3px;" align=center |
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| ==Medical Therapy==
| | ! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF|Tuberculin Rection}} |
| | | ! style="background: #4479BA; width: 450px;" | {{fontcolor|#FFF|Considered a Positive Result in:}} |
| * The treatment of [[impetigo]] depends on the location and number of lesions. Antibiotic therapy could be administered topically or orally.
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| * Topical therapy is preferred for patients with small amount of lesions and without any bullae<ref>{{Cite journal
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| | author = [[Sander Koning]], [[Renske van der Sande]], [[Arianne P. Verhagen]], [[Lisette W. A. van Suijlekom-Smit]], [[Andrew D. Morris]], [[Christopher C. Butler]], [[Marjolein Berger]] & [[Johannes C. van der Wouden]]
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| | title = Interventions for impetigo
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| | journal = [[The Cochrane database of systematic reviews]]
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| | volume = 1
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| | pages = CD003261
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| | year = 2012
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| | month =
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| | doi = 10.1002/14651858.CD003261.pub3
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| | pmid = 22258953
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| }}</ref>; but oral therapy is also accepted.<ref>{{Cite journal
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| | author = [[Ranti S. Bolaji]], [[Tushar S. Dabade]], [[Cheryl J. Gustafson]], [[Scott A. Davis]], [[Daniel P. Krowchuk]] & [[Steven R. Feldman]]
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| | title = Treatment of impetigo: oral antibiotics most commonly prescribed
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| | journal = [[Journal of drugs in dermatology : JDD]]
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| | volume = 11
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| | issue = 4
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| | pages = 489–494
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| | year = 2012
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| | month = April
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| | pmid = 22453587
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| }}</ref>
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| * Oral regimens are used for patients with several lesions and patients with bullous [[impetigo]].
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| * Non-medical therapy involves washing the lesions and the rest of the body with soap and water, and letting the impetigo dry in the air.
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| * Hand-washing and daily bathing is considered a method to prevent impetigo in children.<ref>{{Cite journal
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| | author = [[Stephen P. Luby]], [[Mubina Agboatwalla]], [[Daniel R. Feikin]], [[John Painter]], [[Ward Billhimer]], [[Arshad Altaf]] & [[Robert M. Hoekstra]]
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| | title = Effect of handwashing on child health: a randomised controlled trial
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| | journal = [[Lancet]]
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| | volume = 366
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| | issue = 9481
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| | pages = 225–233
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| | year = 2005
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| | month = July
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| | doi = 10.1016/S0140-6736(05)66912-7
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| | pmid = 16023513
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| }}</ref>
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| * It is very important to remove the crusts before applying ointment, as the [[bacteria]] that cause the disease are located underneath them.
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| * The recommended duration of therapy is 7 days but will depend on the clinical response.
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| <SMALL><font color="#FF4C4C">'''▸ Click on the following categories to expand treatment regimens.'''</font></SMALL>
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| {|
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| <div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #A1BCDD; text-align: center;">
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| <font color="#FFF">
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| '''Bullous Impetigo'''
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| </font>
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| </div>
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| <div class="mw-customtoggle-table01" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
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| <font color="#FFF">
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| ▸ '''Adults'''
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| </font>
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| </div>
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| <div class="mw-customtoggle-table02" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
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| <font color="#FFF">
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| ▸ '''Children'''
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| </font>
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| </div>
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| <div style="border-radius: 0 0 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #A1BCDD; text-align: center;">
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| <font color="#FFF">
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| '''Non-Bullous Impetigo'''
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| </font>
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| </div>
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| <div class="mw-customtoggle-table03" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
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| <font color="#FFF">
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| ▸ '''Adults'''
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| </font>
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| </div>
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| <div class="mw-customtoggle-table04" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
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| <font color="#FFF">
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| ▸ '''Children'''
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| </font>
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| </div>
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| | valign=top | | |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table01" style="background: #FFFFFF;" | |
| | valign=top |
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| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
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| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Bullous Impetigo - Adults†}} | |
| |- | | |- |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen | | | style="padding: 5px 5px; background: #DCDCDC;" | '''≥ 5 mm ''' |
| | | style="padding: 5px 5px; background: #F5F5F5;" | |
| | *HIV-positive person |
| | *Recent contacts of TB case |
| | *Persons with nodular or fibrotic changes on CXR consistent with old healed TB |
| | *Patients with organ transplants and other immunosuppressed patients |
| |- | | |- |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Dicloxacillin]] 250 mg PO q6h''''' <br> OR <br> ▸ '''''[[Cephalexin]] 250 mg PO q6h''''' | | | style="padding: 5px 5px; background: #DCDCDC;" | '''≥ 10 mm ''' |
| | | style="padding: 5px 5px; background: #F5F5F5;" | |
| | *Recent arrivals (less than 5 years) from high-prevalent countries |
| | *Injection drug users |
| | *Residents and employees of high-risk congregate settings (e.g., prisons, nursing homes, hospitals, homeless shelters, etc.) |
| | *Mycobacteriology lab personnel |
| | *Persons with clinical conditions that place them at high risk (e.g., diabetes, prolonged corticosteroid therapy, leukemia, end-stage renal disease, chronic malabsorption syndromes, low body weight, etc) |
| | *Children less than 4 years of age, or children and adolescents exposed to adults in high-risk categories |
| |- | | |- |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen | | | style="padding: 5px 5px; background: #DCDCDC;" | '''≥ 15 mm ''' |
| | | style="padding: 5px 5px; background: #F5F5F5;" | |
| | *Persons with no known risk factors for TB |
| |- | | |- |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left |▸ '''''[[Erythromycin]]‡ 250 mg PO q6h'''''
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| |-
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| | style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | <small>† Adapted from Guidelines for Skin and Soft-Tissue Infections CID 2005<ref>{{Cite journal
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| | author = [[Dennis L. Stevens]], [[Alan L. Bisno]], [[Henry F. Chambers]], [[E. Dale Everett]], [[Patchen Dellinger]], [[Ellie J. C. Goldstein]], [[Sherwood L. Gorbach]], [[Jan V. Hirschmann]], [[Edward L. Kaplan]], [[Jose G. Montoya]] & [[James C. Wade]]
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| | title = Practice guidelines for the diagnosis and management of skin and soft-tissue infections
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| | journal = [[Clinical infectious diseases : an official publication of the Infectious Diseases Society of America]]
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| | volume = 41
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| | issue = 10
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| | pages = 1373–1406
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| | year = 2005
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| | month = November
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| | doi = 10.1086/497143
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| | pmid = 16231249
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| }}</ref> <br> ‡Most S. aureus and Streptococci may be resistant against erythromycin</small>
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| |-
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| |}
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| |}
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| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table02" style="background: #FFFFFF;"
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| | valign=top |
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| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
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| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Bullous Impetigo - Children}}
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| |-
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| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
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| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Dicloxacillin]] 12 mg/kg/day PO divided q6h''''' <br> OR <br> ▸ '''''[[Cephalexin]] 25 mg /kg/day PO divided q6h'''''
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| |-
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| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
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| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left |▸ '''''[[Erythromycin]]‡ 40 mg/ kg/day divided PO q6h'''''
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| |-
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| | style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | <small>† Adapted from Guidelines for Skin and Soft-Tissue Infections CID 2005<ref>{{Cite journal
| |
| | author = [[Dennis L. Stevens]], [[Alan L. Bisno]], [[Henry F. Chambers]], [[E. Dale Everett]], [[Patchen Dellinger]], [[Ellie J. C. Goldstein]], [[Sherwood L. Gorbach]], [[Jan V. Hirschmann]], [[Edward L. Kaplan]], [[Jose G. Montoya]] & [[James C. Wade]]
| |
| | title = Practice guidelines for the diagnosis and management of skin and soft-tissue infections
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| | journal = [[Clinical infectious diseases : an official publication of the Infectious Diseases Society of America]]
| |
| | volume = 41
| |
| | issue = 10
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| | pages = 1373–1406
| |
| | year = 2005
| |
| | month = November
| |
| | doi = 10.1086/497143
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| | pmid = 16231249
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| }}</ref> <br> ‡Most S. aureus and Streptococci may be resistant against erythromycin</small>
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| |-
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| |}
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| |}
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| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table03" style="background: #FFFFFF;"
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| | valign=top |
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| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
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| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Non-Bullous Impetigo - Adults}}
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| |-
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| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Topical Regimen
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| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Mupirocin]] 2% apply to lesions q8h x 7 days''''' <br> OR <br> ▸'''''[[Fusidic acid]] 2% apply to lesions q8h x 7 days''''' <br> OR <br> ▸ '''''[[Retapamulin]] 1% apply to lesions q12h x 5 days'''''
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| |-
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| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Oral Regimen
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| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ ''''[[Dicloxacillin]] 250 mg PO q6h''''' <br> OR <br> ▸ '''''[[Cephalexin]] 250 mg PO q6h''''' <br> OR <br> ▸ '''''[[Erythromycin]] 250 mg PO q6h'''''
| |
| |-
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| | style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | <small> Adapted from Guidelines for Skin and Soft-Tissue Infections CID 2005<ref>{{Cite journal
| |
| | author = [[Dennis L. Stevens]], [[Alan L. Bisno]], [[Henry F. Chambers]], [[E. Dale Everett]], [[Patchen Dellinger]], [[Ellie J. C. Goldstein]], [[Sherwood L. Gorbach]], [[Jan V. Hirschmann]], [[Edward L. Kaplan]], [[Jose G. Montoya]] & [[James C. Wade]]
| |
| | title = Practice guidelines for the diagnosis and management of skin and soft-tissue infections
| |
| | journal = [[Clinical infectious diseases : an official publication of the Infectious Diseases Society of America]]
| |
| | volume = 41
| |
| | issue = 10
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| | pages = 1373–1406
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| | year = 2005
| |
| | month = November
| |
| | doi = 10.1086/497143
| |
| | pmid = 16231249
| |
| }}</ref></small>
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| |-
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| |}
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| |}
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| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table04" style="background: #FFFFFF;"
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| | valign=top |
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| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
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| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Non-Bullous Impetigo - Children}}
| |
| |-
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| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Topical Regimen
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Mupirocin]] 2% apply to lesions q8h x 7 days''''' <br> OR <br> ▸'''''[[Fusidic acid]] 2% apply to lesions q8h x 7 days''''' <br> OR <br> ▸ '''''[[Retapamulin]] 1% apply to lesions q12h x 5 days'''''
| |
| |-
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| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Oral Regimen
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Dicloxacillin]] 12 mg/kg/day PO divided q6h''''' <br> OR <br> ▸ '''''[[Cephalexin]] 25 mg /kg/day PO divided q6h''''' <br> OR <br> ▸ '''''[[Erythromycin]] 40 mg/ kg/day divided PO q6h'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | <small> Adapted from Guidelines for Skin and Soft-Tissue Infections CID 2005<ref>{{Cite journal
| |
| | author = [[Dennis L. Stevens]], [[Alan L. Bisno]], [[Henry F. Chambers]], [[E. Dale Everett]], [[Patchen Dellinger]], [[Ellie J. C. Goldstein]], [[Sherwood L. Gorbach]], [[Jan V. Hirschmann]], [[Edward L. Kaplan]], [[Jose G. Montoya]] & [[James C. Wade]]
| |
| | title = Practice guidelines for the diagnosis and management of skin and soft-tissue infections
| |
| | journal = [[Clinical infectious diseases : an official publication of the Infectious Diseases Society of America]]
| |
| | volume = 41
| |
| | issue = 10
| |
| | pages = 1373–1406
| |
| | year = 2005
| |
| | month = November
| |
| | doi = 10.1086/497143
| |
| | pmid = 16231249
| |
| }}</ref></small>
| |
| |-
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| |}
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| |}
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| |} | | |} |