Cephalexin is unlikely to be successful at treating a Staphylococcal impetigo. Treating that requires either Bactrim or clindamycin.
Pediatric impetigo or something else?Age: 5Weight: 43 lbsRelevant health background: Hes very picky with eating due to some sensory aversions, so he ends up eating a bit of a lopsided diet and barely eats any proteins. He takes multivitamins with iron and no other regular medications. We are in the US, and he is up to date on his vaccines.Maybe relevant maybe not: We live in an area that has brown recluse and black widow spiders. I havent personally seen any. This also began his very first week of Kindergarten. A cough accompanied it, but to be honest my son has a cough 80% of his life.TIMELINESept 2 - My son comes home from Kindergarten and tells me he has a bug bite and his leg hurts. I dont think anything of it, were driving when he tells me this so I dont immediately look.That evening, I see it when giving him a bath. It looks like a bug bite. I put a bandaid on it.Sept 3 - The bug bite is irritating him. Hes scratching at it, I replace the bandaid and give him neosporin.Sept 4 - When I remove the bandaid, the wound has grown considerably. This is the first time I take a photo. Now Im wondering if this was a spider bite. I put some neosporin on and leave it without a bandage Photo: https://imgur.com/a/rB1KJ7BSept 5 - The next day, it looks a bit larger, and with some dots surrounding it. https://imgur.com/a/QdcVImZSept 6 - No change, didnt photographSept 7 - We go to the zoo and he immediately begins complaining about his legs being soooo tired. He was excited to go to the zoo so this was unusual. He whined the whole time and insisted on being carried (hes 5, this is not typical). When we get in the car, he immediately falls asleep. This is important because he had not napped in THREE YEARS. He dropped his naps when he was 2 and never napped since. When we get home, his legs look a lot worse. Not only that, the little bumps around the area have begun popping up all down his back, shoulders, everywhere. https://imgur.com/a/bbCGtFVSept 8 - We visit his pediatrician. He takes one look and diagnosis impetigo. Hes very confident in this. Prescribes topical antibiotic and oral antibiotic for a week. Said he was fine to return to school as long as the wounds werent weeping.Sept 9-16 - The rapid progression stops almost immediately and it begins to heal after about 48 hours on antibiotics. Things are looking good! All my fears of flesh eating bacteria and so on start to go awaySept 21 - Another small sore pops up on the same leg, near his hip. Im immediately suspicious of it, and dont want it to progress, so we go back to the pediatrician the same day.She says it doesnt look anything like the others, and to just keep using the antibiotic ointment, but to add a daily bleach bath (1/4 cup bleach in a tub of water) to help ward off the bacteria living on the skin. She says impetigo is just staph or strep that found its way into a wound and is irritating it, so we just need to keep his skin clean. So we start that.MAYBE RELEVANT - She notes his tonsils are large and does a rapid swab for strep, which is negativeSept 28ish - He has a scrape. Its on the OTHER leg. Hes adamant that he fell and scratched it. We believe him and leave it alone.Oct 1 - Its considerably larger but he also keeps scratching it so were not sure what to think.Oct 2 - We took a walk today and he began complaining that his legs are sooo tired (I cannot stress enough what a hyper boy he is his legs are NOT tired). We go home and that other leg looks IDENTICAL to how the original looked. I go to the urgent care and insist on a skin swab, which they do but since theres no pus, they cannot guarantee accurate results. They prescribe 10 days of Cephalexin but say theyre just not convinced its bacterial. They said it just doesnt look like anything they can readily name.https://imgur.com/a/cObh69dI am worried because it seems to be jumping around his body, made worse by walking/warmth, and hurting his legs more than topical wounds should. I also cant shake that the cough is still there.I also feel dismissed when I repeatedly ask if the cough and exhaustion could be related to his wounds.What do YOU think?