Impetigo

NICE Guideline [NG153] Impetigo: antimicrobial prescribing. Published: Feb 2020. NICE CKS Impetigo. Last revised: Jul 2024.

Background Information

Highly contagious, superficial bacterial skin infection.

2 main types of impetigo:
  • Non-bullous impetigo: characterised by the progression of macule → pustule / vesicle → honey-coloured crust
  • Bullous impetigo: characterised by flaccid bullae that contains yellow fluid

Most common: staphylococcus aureus 

Also: streptococcus pyogenes

Guidelines

Clinical diagnosis, investigations not routinely needed.

Only consider swabs for culture and sensitivities if:
  • Failed to respond to treatment
  • Recurrent / widespread impetigo
  • Doubt about diagnosis
  • MRSA suspected

Advice on:
  • Impetigo is usually self-limiting (heals in 7-21 days without treatment)
 
  • Hygiene measures
 
  • Exclusion recommendations (childcare facilities / school / work)
    • Until all lesions are crusted and healed, or
    • 48 hours after starting antibiotic

Choice of route and drug depends on the type of extend of impetigo.
 

Choice depends on extend of impetigo:
  • Localised disease: hydrogen peroxide 1% (BD / TDS for 5 days)
 
  • Widespread disease: topical or oral antibiotic for 5 days
    • Choice of topics antibiotic: 1st line fusidic acid 2%, 2nd line mupirocin 2%
    • Choice of oral antibiotic: 1st line flucloxacillin, 2nd line clarithromycin, erythromycin for pregnancy

Offer oral antibiotic for 5 days:

  • 1st line: flucloxacillin
  • 2nd line: clarithromycin 
  • Pregnant: erythromycin 

Step up accordingly, depending on what has been started:
  1. Topical antibiotic
  2. Oral antibiotic
  3. Consider skin swab

References



Author: Adams Lau
Reviewer:
Last Edited: 12/03/25