New draft guidance from NICE and Public Health England says that a topical antiseptic, such as hydrogen peroxide 1% cream, is as effective as a topical antibiotic in patients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.
If symptoms have not improved, or worsened, following 5 to 7 days' 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, NICE said.
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.
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.
NICE said that patients should not be treated with both topical and oral antibiotics as there was no evidence to suggest that prescribing both was more effective than a topical treatment alone.
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. It is open for consultation until 11 September.