Impetigo contagiosa

Minor / localised infection

First line: Hydrogen peroxide 1% cream topically 8-12 hourly

Second line: Fusidic acid 2% topically 8 hourly

If known or suspected MRSA carriage: Mupirocin 2% topically 8 hourly

Widespread infection

First line: Flucloxacillin oral 250-500mg 6 hourly

If true penicillin / beta-lactam allergy: Clarithromycin oral 250-500mg 12 hourly

If known or suspected MRSA: Doxycycline oral 200mg as a STAT dose, followed by 100mg 12 hourly

N.B. In pregnant patients, doxycycline is contraindicated.

Non-bullous impetigo (crusted impetigo) is the most common form and usually affects the area around the nose and mouth. Lesions begin as vesicles or pustules, which burst and develop yellow-golden crusts.  

Topical antibiotics should be only be used for very localised lesions and systemic antibiotics used for extensive, severe or bullous impetigo.

Impetigo is diagnosed clinically and swabs are usually not required. Take a swab for bacterial culture if the infection is: very extensive or severe, recurrent, suspected to be a community outbreak, or suspected to be caused by MRSA. Review any culture results and ensure that an appropriate antibiotic has been prescribed.

General advice: Hygiene measures, such as daily changes of towels and bed linen, are important to aid healing and stop the infection spreading to other sites on the body and to other people.