Warning

CKS
NICE guidance (endorsed by British Association of Dermatologists)

Non bullous (not systemically unwell or at high risk of complications)
Usually self-limiting, give hygiene measures and exclusion advice from school/work as per NICE Clinical Knowledge Summary.
If indicated, topical antibiotics can be used. Do not offer combination treatment with topical AND oral antibiotics.
Bullous impetigo or non-bullous impetigo with sepsis or high risk of complications: use oral antibiotics.  Can increase duration to 7 days if appropriate (based on clinical judgement).

For glossary of terms see Glossary.

Drug details

Non bullous infection

Hydrogen peroxide 1% cream.  Apply two to three times a day.

5 days

If hydrogen peroxide cream unsuitable

Fusidic acid 2% ointment.  Apply three times daily.

5 days

If resistance to fusidic acid is suspected or confirmed

Mupirocin 2% cream.  Apply three times daily.

5 days

Extensive, severe or bullous impetigo

Flucloxacillin 500mg four times daily

5 days.  Can increase duration to 7 days if clinically appropriate.

In penicillin allergy

Clarithromycin 500mg twice a day

5 days.  Can increase to 7 days if clinically appropriate.

MRSA suspected or confirmed or drug interaction with clarithromycin

Doxycycline 100mg twice daily

5 days.  Can increase to 7 days if clinically appropriate.

Editorial Information

Last reviewed: 25/06/2024

Next review date: 25/06/2027

Author(s): Antimicrobial Management Team.

Version: 2

Approved By: TAM Subgroup of ADTC

Reviewer name(s): Alison Macdonald, Area Antimicrobial Pharmacist.

Document Id: AMT168