Discuss with all:
1. Expected clinical response including timeframes.
2. The importance of taking antibiotics as prescribed until course is complete.
3. The need to seek immediate advice if:
- Antibiotics are not tolerated.
- Skin signs worsen or are not improved after 48 hours (although warn them that there may be an initial increase in redness).
- Systemic symptoms develop or worsen (e.g. high temperature, going off feeds or nausea and vomiting, unsettled behaviour or less alert/sleepy).
4. General advice
- Attention to hand washing for all family members and before and after dressing infected skin.
- Regular bathing but do not share bathwater-showering maybe preferable while infection.
- Janola (Sodium hypochlorite 1 capful/15mls to 10litres water) baths once or twice weekly.
- Launder sheets, towels and clothing using disinfectant or hot water or hot iron.
- Limit sharing of beds, sheets and towels during infection, infestations.
- Trim finger and toenails.
- Encourage elimination of mosquito and other insect triggers.
5. Specific advice
Advice for patients with impetigo
- To remove crusted areas:
- If patients wish to remove crusted areas, soak a clean cloth in a mixture of half a cup of white vinegar in a litre of tepid water. Apply this compress to affected areas for about ten minutes several times a day and then gently wipe away crust.4 Topical antibiotic can then be applied. Note: bullous impetigo should not be lanced.
- To prevent the spread of infection:
- Children should stay away from day-care or school until the lesions have crusted over or they have received at least 24 hours of antibiotic treatment. This may be less important for older children (e.g. secondary school) because they may be less likely to spread the infection through touching each other.
- Cover the affected areas and wash hands after touching patches of impetigo or applying antibiotic cream or ointment.
- Avoid close contact with other people.
- Use separate towels, flannels, clothing and bathwater until the infection has cleared. Disinfect linen and clothing by hot wash, hot dry or ironing.
- Use hand sanitisers and/or careful washing with household soap and water, several times daily.
Advice for patients with cellulitis
- Advise about symptomatic treatment:
- Use paracetamol or ibuprofen for pain and fever.
- Drink adequate fluids to prevent dehydration.
- Rest and or elevate the affected area for comfort and to relieve oedema (where applicable).
- Advise to keep the child at home until mobility is normal and child is well.
6. Make arrangements to see those who need a clinician review.
Last updated : Thursday, May 18, 2017
Next review date : Friday, May 18,2018
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