Impetigo (Antimicrobial)
TAM (Treatments and Medicines) NHS Highland
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.