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Management

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Diagnosis:

  • lesions can be swabbed and samples sent for culture
  • NICE (1) do not suggest mandatory initial swabbing of lesions but note:
    • if a skin swab has been sent for microbiological testing:
      • review the choice of antibiotic when results are available and
      • change the antibiotic according to results if symptoms are not improving, using a narrow-spectrum antibiotic if possible

Topical treatment:

  • topical fusidic acid or mupirocin
    • there is evidence that topical antibiotics may be slightly more effective than oral antibiotics for patients with limited non-bullous impetigo (2). Disinfecting treatments are not effective (2)
    • topical antibiotic therapy is indicated in localized cases without complications (3)
      • topical mupirocin is a very effective treatment option
      • topical fusidic acid cream an effective treatment for impetigo with very few side-effects, equally effective, in fact, as mupirocin.

Systemic treatment - if widespread

  • systemic antimicrobials are the treatment of choice for widespread infections and infections complicated by systemic symptoms (3)
  • recommended oral antibiotic choices are flucloxacillin or erythromycin, or a cephalosporin such as cefalexin or cefradine (4)

NICE suggest an algorithm for treatment based on features of the impetigo presenting to the clinician (1):

 

Antibiotic treatments have been suggested by NICE (1):

 

 

Patient eduction:

  • good handwashing techniques
  • avoid scratching - cutting finger-nails may be useful

Notes:

  • previously been stated that topical treatment for 7 days is generally adequate for limited disease - the maximum duration of topical treatment is 10 days (4)
    • if using systemic treatment and streptococcal infection is suspected then add phenoxymethylpenicillin to flucloxacillin (co-amoxiclav is an alternative to using phenoxymethylpenicillin and flucloxacillin together)

Reference:

  1. NICE (February 2020).Impetigo: antimicrobial prescribing
  2. Koning S etl al (2004). Interventions for impetigo. Cochrane Database Syst Rev 2004; (2)CD003261.
  3. Brown J et al. Impetigo: an update. Int J Dermatol. 2003 Apr;42(4):251-5
  4. Prescriber (2004); 15 (13): 35-40.
  5. Public Health England (June 2021). Managing common infections: guidance for primary care

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