Impetigo
Topical treatment may be appropriate in very localised lesions
Apply every 8 hours for 5 days
For people who are not systemically unwell or at a high risk of complications
Apply two or three times daily for 5 days
Prescribing Notes:
- Increasing concerns about the development of resistance have led to topical antibiotic therapy being discouraged.
- Topical antiseptics may be used to remove crust and to prevent spread of infection, but there is no evidence to support their use in preference to washing with soapy water.
- All wounds have potential for bacterial infection and may become colonised but swabs should only be taken if there are clinical signs of infection.
History Notes
15/12/2021
East Region Formulary content agreed.
500mg every 6 hours for 5 days
500mg every 6 hours for 5 days
For penicillin allergy
500mg every 12 hours for 7 days
500mg every 12 hours for 7 days
Prescribing Notes:
- Increasing concerns about the development of resistance have led to topical antibiotic therapy being discouraged. Fusidic acid, three times daily for 5 days, may be appropriate in very localised lesions.
- When MRSA is isolated by Microbiology follow suppression advice in the Infection Control Manual.
- Flucloxacillin has adequate streptococcal cover; therefore it is not necessary to prescribe penicillin in addition, for empirical treatment of non-severe cellulitis. If there has been exposure to river or sea water, discuss treatment with a microbiologist.
- All wounds have potential for bacterial infection and may become colonised but swabs should only be taken if there are clinical signs of infection.
- Prescription of antibiotics should not delay appropriate surgical management e.g. drainage or aspiration of an abscess.
History Notes
15/12/2021
East Region Formulary content agreed.
For people who are not systemically unwell or at a high risk of complications.
Refer to BNFc for dose and duration.
Topical treatment may be appropriate in very localised lesions.
Refer to BNFc for dose and duration.
Prescribing Notes:
- Treatments are available via Pharmacy First, refer to Pharmacy First - Impetigo.
- Increasing concerns about the development of resistance have led to topical antibiotic therapy being discouraged.
- Topical antiseptics may be used to remove crust and to prevent spread of infection, but there is no evidence to support their use in preference to washing with soapy water.
- All wounds have potential for bacterial infection and may become colonised but swabs should only be taken if there are clinical signs of infection.
- For more information, including management of widespread non-bullous impetigo refer to NICE CKS: Impetigo.
- A patient information leaflet on Impetigo can be downloaded from the British Association of Dermatologists website.
History Notes
15/01/2024
East Region Formulary content agreed.
Refer to BNFc for dose and duration.
Refer to BNFc for dose and duration.
Refer to BNFc for dose and duration.
Refer to BNFc for dose and duration.
For penicillin allergy.
Refer to BNFc for dose and duration.
Refer to BNFc for dose and duration.
Refer to BNFc for dose and duration.
Refer to BNFc for dose and duration.
Prescribing Notes:
- Provide written information about impetigo. A patient information leaflet on Impetigo can be downloaded from the British Association of Dermatologists website.
- For more information, refer to NICE CKS: Impetigo.
- Advise that hygiene measures are important to aid healing and stop the infection spreading to other sites on the body and to other people, and recommend that the person:
- Washes the affected areas with soapy water.
- Washes the hands after touching a patch of impetigo, and after applying antibiotic cream.
- Avoids scratching affected areas, and keeps fingernails clean and cut short.
- Avoids sharing towels, flannels, clothing, and bathwater until the infection has cleared.
- Children and adults should stay away from school or work until the lesions are dry and scabbed over, or, if the lesions are still crusted or weeping, for 48 hours after antibiotic treatment has started.
- Advise the person to attend a follow-up appointment if there is no significant improvement after 7 days.
- Increasing concerns about the development of resistance to fusidic acid and mupirocin, have led to topical antibiotic therapy being discouraged. Topical fusidic acid should only be used for very localised lesions. Refer to pathway for treatment of non-bullous impetigo.
- When MRSA is isolated by Microbiology follow suppression advice in the Infection Control Manual.
- Flucloxacillin has adequate streptococcal cover; therefore it is not necessary to prescribe penicillin in addition, for empirical treatment of non-severe cellulitis. If there has been exposure to river or sea water, discuss treatment with a microbiologist.
- All wounds have potential for bacterial infection and may become colonised but swabs should only be taken if there are clinical signs of infection.
- Prescription of antibiotics should not delay appropriate surgical management e.g. drainage or aspiration of an abscess.
History Notes
15/01/2024
East Region Formulary content agreed.
Dose according to age and product licence.
Supplied under PGD
Dose according to age and product licence.
Prescribing Notes:
- Crystacide may be used to treat superficial bacterial skin infections such as impetigo. It should be applied 2-3 times daily for up to 3 weeks.
- May bleach fabrics.
History Notes
05/04/2023
Updating Hydrogen peroxide product description to 'Hydrogen peroxide 1% cream' to align with Pharmacy First list.
27/10/2020
Content migrated from ‘East Region Formulary: Pharmacy First - supporting minor ailments’ document.