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Bullous impetigo - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Very Good Posted in: Skin Hair and Nails
Answered by

General & Family Physician
Practicing since : 2004
Answered : 37 Questions
Doctor :   Hi
Doctor :   How can I help you?
User :   We have had bullous impetigo for 8 weeks. Had 12 days of heracillin (flucloxacillin) for the whole family (7 years old, 10 months old and 2 adults) but it only reduced the blisters, didn´t take them away.Swabs from blisters show nothing (small blisters but many) The 7 year old started it with blisters on her buttocks. We wash hands often, wash all linnen and clothing every day use one-time towels, shower every day, keep short nails, wipe off all contact areas every day (it takes LOADS of time). Can a faeces sample show what bacterias it is (guess it is allways staff aereus) and if they are resistant bacterias? THe adults has taken nasopharynx test- also showed nothing.
Doctor :   Let me read the query.
Doctor :   Let me guide you.
Doctor :   The main source of infections are by direct contact.
Doctor :   And mainly affect the skin.
Doctor :   A fecal examination is unlikely to show a positive report unless if a gut symtoms are also seen with the skin symptoms.
User :   I just read somewhere that you can have the staff a:s in your nose or in your perineum, and because it started around the perineum on the 7 year old and we haven´t been able to find the bacterias in the other tests I thought it might be an idea to check that? We "only" have skin symptoms, but we just need to get this right, before getting "crazy":)
Doctor :   Staphylococcus is an organism causing localised skin infections.
Doctor :   They can occasionally cause infections in the gut. but since there is no history of diarrhea or vomiting.
Doctor :   Its unlikely that the infection has spread from the bowel.
Doctor :   Have you followed what I have suggested?
User :   So it isn´t true that the staff a can be in your perineum and come from there? (I read that in a doctor´s manual for infections)
Doctor :   The parts mainly affected by the staph organisms are the skin, upper respiratory tract and the lungs.
Doctor :   The skin of the perineum, yes, but not the mucosa or the rectum
Doctor :   The skin around the anal region, the perineum one of the sites.
Doctor :   But they may not appear on the stools.
Doctor :   Have you followed what I have suggested?
User :   We have done all suggested things but nothing helps, and the doctor we visit doesn´t want to prescribe any antibiotics without knowing if there is any resistance (which there should be, because the flucloxacillin didn´t help that much...?) All other things are done..
Doctor :   With appropriate medications and good personal hygeine, this should improve.
Doctor :   Since the penicillin group of antibiotics have been resistant to this, you may need other group of antibiotics.
Doctor :   I cannot prescribe the other antibiotics online here as its not ethical.
User :   Yes, but how do we know what appropriate medications are, when the swab test and nasopharynx test doesn´t give any results more than normal skinbacteria, despite that there is a lot of blisters?
Doctor :   When was the swab test done?
Doctor :   And when did you last take the antibiotic?
User :   What antibiotic group would you recommend, so that I can tell the doctor a suggestion? The swab test was made 1 1/2 week ago and we ended antibiotics 3 1/2 week ago
Doctor :   Ok
Doctor :   Since flucloxacin antibiotic has not been effective, other pencillin groups or the cephalosporin groups may be effective.
User :   So there is not commonly cross-resistance?
Doctor :   If the blisters are severe, preferrably injectable form of these medications for a few days followed by oral group is a better choice.
Doctor :   Since you do not have a report on the organisms, I cannot comment on the possibility of resistance.
Doctor :   And before starting on these antibiotics, it may be worth repeating the swab test again.
User :   There are many blisters but they are not large. swedish doctrors are very restrictive with antibiotics, so I guess they wont´give us anything more
Doctor :   If the blisters have reduced considerably, then there are more chances that they may slowly disappear.
Doctor :   you will just have to strictly follow good personal hygeine.
Doctor :   But if there is no way of restarting antibiotics, then I will suggest you to take a second opinion from a dermatologist.
User :   They have been reduced but then come up strong again and then reduces with the cream muporicin/BACTROBAN, BUT new blisters are coming up all the time. We do follow strict personal hygiene for the whole family
Doctor :   A personal examination of the blisters can provide better information regarding if the antibiotics are necessary or they can be left alone.
Doctor :   Have you followed what I have suggested?
User :   In my country there are no private doctor´s and you have to wait for about 3 months to get an appointment with a dermatologist.. And it is forbidden to send your child to school or daycare with impetigo... So after REALLY doing everything we can with hygiene and washing I guess we can just try to get another type of antibiotics and hope for the best?
Doctor :   Recurrence of the blisters are an indication that you may have to improve on the personal hygiene a bit more.
Doctor :   I understand that you are taking all precautions.
Doctor :   But let me include a few more suggestions apart from washing hands.
User :   Sorry, but that is impossible, we spend hours every day to clean and to take care of the hygiene (also using gloves when treating the blisters)
User :   I gladly take any suggestions to do better, though
Doctor :   1. Apart from the personal hygiene, you also need to take precautions in keeping the surroundings clean.
Doctor :   This include the clothes that one uses, the bedsheets, pillow covers, window screens,
Doctor :   infact every thing that can come in contact has to cleaned.
Doctor :   Washed well and then reused.
Doctor :   Dust and allergens can increase the chances of symptom development which can get secondary infections.
Doctor :   Hence 2. Keep the room free from those.
Doctor :   Simple suggestions for this are mopping the home, keeping the window curtains closed.
Doctor :   3. if you find a new blister/cuts or any new eczematous lesions, you can cover those with the topical antibiotics that you have.
Doctor :   This will prevent those from getting infected and thereby restricting the infections.
Doctor :   4. Use seperate soaps, towels for all your family members.
Doctor :   5. If necessary keep the clothes that one uses also seperated.
Doctor :   These are few tips that I would like to share with you.
Doctor :   Finally, if the symptoms are persisting inspite of repeated efforts, then its worth getting a second opinion from a dermatologist and the use of a second antibiotic.
Doctor :   Have you followed what I have suggested?
User :   Yes, we are doing all of the above... But What do you meen with well and then reused? ANd should we not wash clothes from different family members together (we use 60 degrees)
Doctor :   I did not mean that.
Doctor :   You can wash them together, I only meant to keep them seperated if you can do it.
Doctor :   This may reduce the chances of cross infections.
Doctor :   I apologise if my sentences meant differently.
User :   You meen to seperate clothes in cupboards etc? That meens not having clothes from different family members stored together in cupboards etc?
Doctor :   yes, if its possible that way.
Doctor :   then you can add this to in the tasks.
Doctor :   This is just as a precautionary measure to prevent cross infections.
User :   We have had clothes stored separately, but been washing them together..
Doctor :   Thats is fine.
User :   Ok, guess there´s not much more we can do, just try to get a doctor who can give us the right medication...Which is hard here.:)
Doctor :   Do you have any other query that i can assist you with?
User :   NO thank you, that´s all for now.
Doctor :   Thanks for consulting me. Bye for now.
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