NICE and Public Health England (PHE) have issued final antimicrobial prescribing guidance on impetigo.
In the final guidance, NICE and PHE highlight that hydrogen peroxide 1% cream, a topical antiseptic, is just as effective at treating non-bullous impetigo as a topical antibiotic.
Hydrogen peroxide 1% cream should be considered for people with localised, non-bullous impetigo if they aren’t systemically unwell or at risk of developing any complications. Although other topical antiseptics are available for treating superficial skin infections, no evidence was found for using them to treat non-bullous impetigo.
Impetigo is a highly contagious bacterial infection that affects the surface of the skin and is characterised by red sores and blisters which can develop into yellow/brown crusted patches. Although impetigo usually clears up within two to three weeks without treatment, it is normally treated with an antibiotic to help reduce the spread of infection and speed up recovery.
If hydrogen peroxide is not suitable, a short course of a topical antibiotic should be given instead (such as fusidic acid 2%). For people with widespread non-bullous impetigo, a topical or oral antibiotic (such as flucloxacillin) should be offered, taking account of various factors including antimicrobial resistance, which can develop rapidly with extended or repeated use of topical antibiotics.
An oral antibiotic should be given in the first instance if the person has bullous impetigo or if they are systemically unwell or at risk of developing any complications.
The guidance also now recommends that combination treatment with a topical and oral antibiotic should not be used to treat impetigo. Using both oral and topical treatments is no more effective than using a single topical treatment alone.
The overuse of antimicrobials is contributing to a global threat of antimicrobial resistance. The NICE/PHE antimicrobial prescribing suite of guidelines focuses on a variety of common bacterial infections and makes recommendations on appropriate antibiotic choice and use.