Final guidance on impetigo published by NICE and Public Health England says that hydrogen peroxide 1% cream is just as effective as a topical antibiotic in patients with localised, non-bullous impetigo, providing they are not systemically unwell or at risk of developing any complications.
According to the guidelines, if hydrogen peroxide 1% cream is unsuitable then GPs should offer a short course of a topical antibiotic. NICE found no evidence to support the use of any other topical antiseptics to treat the condition.
If symptoms have not improved, or worsened, following treatment with a topcial antiseptic, patients should be prescribed a topical antibiotic if the condition is still localised. GPs could consider an oral antibiotic if the impetigo has become more widespread, the guidance says.
Patients with widespread non-bullous impetigo who are not systemically unwell should be prescribed a topical or oral antibiotic, according to the guidance.
Oral antibiotics should be prescribed to patients with bullous impetigo, or if they are systemically unwell or at high risk of complications.
Patients should not be offered combination treatment with a topical and oral antibiotic. NICE said there was no evidence to suggest that prescribing both was more effective than a topical treatment alone.
The guidance says that first-line topical antiobiotic treatment should be fusidic acid 2%, with the second choice mupirocin 2%. First-line oral antibiotics should be flucloxacillin, with clarithromycin as a second choice, or erythromycin in women who are pregnant.
The guidance is part of a series of advice on antimicrobial prescribing for managing common infections from NICE, which has been developed with Public Health England. NICE had consulted on a draft version of this latest guidance last year.