What criteria should I use to decide whether to prescribe antibiotics for impetigo in a patient?

Antibiotics should be prescribed for impetigo if:

• Hydrogen peroxide 1% cream is ineffective for localized non-bullous impetigo, and a short course of topical antibiotic is offered.
• Impetigo becomes widespread after initial treatment, warranting a short course of topical or oral antibiotics.
• Topical antibiotics are unsuccessful, and an oral antibiotic is indicated.
• The infection is worsening or has not improved after completing a course of antibiotics, prompting microbiological testing and possible treatment adjustment.
• Recurrent impetigo with frequent episodes, where microbiological testing and decolonization are considered.

Additionally, the decision to prescribe antibiotics should consider clinical judgment, severity, extent of infection, and response to initial treatments ¹.