Diagnostic and Therapeutic Hindrance of Severe Non-bullous Impetigo Contagiosa in a Rural Nepalese Child: A Case Report

Abstract

Impetigo is a common, contagious superficial bacterial skin infection predominantly affecting children aged two to five years. Severe presentations are rare but can be diagnostically and therapeutically challenging, particularly in rural, resource-limited settings. We report a 7-year-old girl from rural Nepal with severe non-bullous impetigo contagiosa unresponsive to initial therapy with topical mupirocin and oral cephalexin. Due to the absence of culture and sensitivity facilities and the high regional prevalence of methicillin-resistant Staphylococcus aureus (MRSA), empirical oral doxycycline was initiated. Marked improvement occurred within 48 hours, with complete resolution by day 7. This case underscores the importance of flexible, evidence-based empirical therapy for suspected MRSA in pediatric patients when diagnostic resources are unavailable, and highlights the short-term safety and efficacy of doxycycline in children.