A child presents with extensive bullous impetigo involving the face and body. Which treatment is best?

• A. Topical Mupirocin
• B. Oral Dicloxacillin
• C. Oral Penicillin
• D. Topical Clindamycin

Answer: (B)

Extensive bullous impetigo in a child requires systemic therapy that reliably covers Staphylococcus aureus, which is the typical culprit and often produces exfoliative toxins leading to bullae. Topical antibiotics work well for localized, limited lesions, but they won’t adequately address disease spread across the face and body. Plain penicillin is often ineffective because many S. aureus strains produce penicillinase, rendering it useless against these bacteria. A penicillinase-resistant penicillin like dicloxacillin provides reliable activity against S. aureus and is appropriate for pediatric skin infections when MRSA is not suspected. So oral dicloxacillin offers the necessary systemic coverage for widespread disease, making it the best choice in this scenario.

If MRSA were a concern, alternatives such as clindamycin or other agents might be considered, but for typical extensive bullous impetigo without MRSA risk, dicloxacillin is preferred.