A primary care NP sees a child who has honey-crusted lesions with ...

[captainjonesify]

A primary care NP sees a child who has honey-crusted lesions with areas of erythema around the nose and mouth. The child's parent has been applying Polysporin ointment for 5 days and reports no improvement in the rash. The NP should prescribe:
 
  a. mupirocin.
  b. neomycin.
  c. a systemic antibiotic.
  d. Polysporin with a corticosteroid.

Question 2

A primary care NP is considering using a topical immunosuppressive agent for a patient who has atopic dermatitis that is refractory to treatment with topical corticosteroids. The NP should:
 
  a. begin therapy with pimecrolimus (Elidel).
  b. tell the patient that these agents may be used long-term.
  c. counsel the patient that these agents are more likely to cause skin atrophy.
  d. tell the patient that laboratory monitoring for hypothalamic-pituitary-adrenal (HPA) suppression will be necessary.

[Brummell1998]

Answer to Question 1

A
Treatment with a topical antiinfective agent should be reevaluated in 3 to 5 days if there is no improvement. Polysporin ointment is bacteriostatic, not bacteriocidal. Mupirocin is indicated for impetigo caused by Staphylococcus aureus, which is most common in children. Neomycin is an aminoglycoside and is not effective against S. aureus. A systemic antibiotic is not indicated unless the mupirocin fails to treat the infection. Adding a corticosteroid would increase the likelihood that the infection will worsen.

Answer to Question 2

A
Topical calcineurin agents are considered second-line agents for treating atopic dermatitis and should be limited to use in patients who have failed treatment with other therapies. Pimecrolimus permeates skin at a lower rate than tacrolimus and so should be tried first. These agents are for short-term use only because of the risk of skin cancer. These agents are less likely than steroids to cause skin atrophy, and HPA suppression is not a risk.

[captainjonesify]

TYSM

[amandanbreshears]

Excellent