impetigo (antimicrobial prescribing)

• Localised non-bullous impetigo: start with topical antiseptic (hydrogen peroxide 1% cream) when appropriate.
• Antibiotics: use short courses; choose topical if localised and suitable, oral if widespread or systemic features.
• Reassess if rapidly worsening or not improving after the course; consider swab if recurrent/non-responsive.

• Topical antiseptic: Hydrogen peroxide 1% – apply 2–3 times daily for 5 days.
• First-choice topical antibiotic (if antiseptic unsuitable/ineffective): Fusidic acid 2% – apply three times daily for 5 days.
• Alternative topical antibiotic (if resistance suspected/confirmed): Mupirocin 2% – apply three times daily for 5 days.
• First-choice oral antibiotic: Flucloxacillin 500 mg QDS for 5 days.
• Penicillin allergy (not pregnant): Clarithromycin 250 mg BD for 5 days (may increase to 500 mg BD if severe).
• Penicillin allergy in pregnancy: Erythromycin 250–500 mg QDS for 5 days.

Course length: 5 days usually; may extend to 7 days if clinically needed.

• Same-day/acute: suspected cellulitis/systemic illness, or severe spreading disease.
• Consider referral: bullous impetigo in infants, immunocompromised with widespread disease, frequent recurrences (consider decolonisation work-up).