Topical Antimicrobial Ointments for Blisters in Pediatric Patients

First-Line Treatment Options

Mupirocin 2% topical ointment is the recommended first-line antimicrobial for preventing infection in pediatric patients with blisters and minor skin infections, according to the Infectious Diseases Society of America 1, 2, 3
Mupirocin 2% topical ointment should be applied three times daily to blister sites for 7-10 days to prevent secondary bacterial infection, as recommended by the Clinical Infectious Diseases guidelines 1, 2

Chlorhexidine antiseptic washes can be used as an adjunctive therapy to help prevent infection in blisters, as suggested by the American Academy of Dermatology 4, 5
Diluted bleach baths (1 teaspoon per gallon of bath water for 15 minutes twice weekly) may be considered for patients with recurrent skin infections, according to the Clinical Infectious Diseases guidelines 6

Blisters should generally be left intact when possible to prevent secondary bacterial infection, as recommended by the British Association of Dermatologists 7
If blisters are large or in functionally problematic areas, they may be pierced with a sterile needle to release fluid while leaving the blister roof intact, as suggested by the British Association of Dermatologists 7
For extensive areas of erosion, antiseptics such as potassium permanganate baths or antiseptic-containing bath oils may help dry lesions and prevent infection, according to the British Association of Dermatologists 7
Painful eroded areas may be covered with low-adhesion dressings held in place with soft elasticated viscose, as recommended by the British Association of Dermatologists 7

Monitor for signs of increasing erythema, warmth, pain, or purulent drainage that may indicate secondary infection requiring systemic antibiotics, as recommended by the Clinical Infectious Diseases guidelines 1, 2
Consider obtaining bacterial cultures if infection is suspected or if there is inadequate response to initial topical therapy, according to the Clinical Infectious Diseases guidelines 1

If secondary infection develops or for more extensive infections, systemic antibiotics may be necessary, as recommended by the Clinical Infectious Diseases guidelines 2, 3
For systemic therapy in pediatric patients, first-line options include Clindamycin (10-13 mg/kg/dose IV every 6-8 hours) if local clindamycin resistance rates are low (<10%), according to the Clinical Infectious Diseases guidelines 1, 2
Cephalexin (25 mg/kg/day in 4 divided doses) may be considered for methicillin-susceptible infections, as suggested by the Infectious Diseases Society of America 8
Tetracyclines should be avoided in children under 8 years of age due to risk of dental staining, as recommended by the American Academy of Pediatrics and the Clinical Infectious Diseases guidelines 1, 2, 4

Maintain good personal hygiene with regular bathing and hand washing, as recommended by the Clinical Infectious Diseases guidelines 1
Keep draining wounds covered with clean, dry bandages, according to the Clinical Infectious Diseases guidelines 1
Avoid sharing personal items that contact skin, as suggested by the Clinical Infectious Diseases guidelines 1
Focus cleaning on high-touch surfaces that may contact bare skin, according to the Clinical Infectious Diseases guidelines 1