Impetigo
Advise people with impetigo, and their parents or carers if appropriate, to seek medical help if symptoms worsen rapidly or significantly at any time, or have not improved after completing a course of treatment.
Reassess people with impetigo if their symptoms worsen rapidly or significantly at any time or have not improved after completing a course of treatment.
When reassessing people with impetigo, take account of:
- other possible diagnoses, such as herpes simplex.
- any symptoms or signs suggesting a more serious illness or condition, such as cellulitis.
- previous antibiotic use, which may have led to resistant bacteria.
Advise people with impetigo, and their parents or carers if appropriate, about good hygiene measures to reduce the spread of impetigo to other areas of the body and to other people.
Localised non-bullous impetigo
Preferred
Fusidic acid 2% cream, apply TDS for 5 days
Alternative
If fusidic acid resistance suspected or confirmed: Mupirocin 2% cream Apply TDS for 5 days
If Impetigo is worsening or has not improved after completing a course of topical antibiotics:
- Offer a short course of oral antibiotics (see section below) AND
- Consider sending a skin swab for microbiological testing. Review treatment when sensitivities are available.
Widespread non-bullous impetigo OR bullous impetigo OR systemically unwell or at high risk of complications
Note: If impetigo is worsening or has not improved after completing a course of oral antibiotics consider sending a skin swab for microbiological testing.
flucloxacillin po
| Age | flucloxacillin oral dose |
| 1 month to 1 year | 62.5 mg to 125 mg QDS for 5 days |
| 2 to 9 years | 125 mg to 250 mg QDS for 5 days |
| 10 to 17 years | 250 mg to 500 mg QDS for 5 days |
If flucloxacillin po not tolerated (ie. suspension unpalatable) alternative is: cefalexin 25 mg/kg (max 1g) po TDS
For penicillin allergy (severe and non-severe)
clarithromycin po, see dosing table, for 5 days
| Weight | clarithromycin oral dose |
| under 8 kg | 7.5 mg/kg BD |
| 8 to 11 kg | 62.5 mg BD |
| 12 to 19 kg | 125 mg BD |
| 20 to 29 kg | 187.5 mg BD |
| 30 to 40 kg | 250 mg BD |
| 12 to 17 years | 500 mg BD |
In pregnancy: erythromycin 250 mg to 500 mg QDS for 5 days
Recurrent impetigo
Send a skin swab for microbiological testing and;
- Consider taking a nasal swab and starting treatment for MRSA decolonisation
- Review treatment when sensitivities are available.