Title
Examination:
Non-bullous lesions (75%, staph aureus or strep or both)?
Bullous lesions (25%, staph aureus)?
Complications:
- Cellulitis?
- ‘Scalded skin syndrome’?
- Post-strep complications (eg scarlet fever, glomerulonephritis)?
- Sepsis?
Investigations:
Skin swab if no improvement after initial treatment with topical or oral antibiotic?
If frequently recurrent: skin swab and nasal swab to test for the carriage of staphylococcus?
Management:
Refer for urgent assessment:
- Widespread and immune-compromise
- Bullous impetigo in infants under 1 year
- Sepsis
Localised non-bullous impetigo:
First-line: topical antiseptic (eg hydrogen peroxide 1% cream) tds for 5-7 days
Second-line: a topical antibiotic if antiseptic not suitable (eg fusidic acid 2% apply ads for 5-7 days)
Widespread non-bullous impetigo:
Topical fusidic acid or oral antibiotic
Bullous impetigo or if systemically unwell or high risk of complications:
Oral flucloxacillin (or clarithromycin if allergic or flucloxacillin unsuitable) for 7 days.
Do NOT offer a combination of oral and topical antibiotics in impetigo
If no improvement after initial treatment with topical fusidic acid:
Switch to topical mupirocin, if fusidic acid resistance suspected or confirmed on swab or oral antibiotic
If MRSA identified:
Get local expert advice
Recurrent impetigo:
If frequently recurrent: skin and nasal swab to test for the carriage of staphylococcus and start treatment for nasal and skin decolonisation if present
Staph carriage:
Elimination with naseptin qds for 10 days (avoid if peanut or soya allergic and use mupirocin instead)
Decolonise skin with chlorhexidine 4% body wash (hibiscrub) for 5 days (apply directly to wet skin and leave for 1 minute before rinsing off) or Dermol® (emollient containing chlorhexidine) if skin condition or sensitive skin
Advised:
Off school/childcare settings until lesions crusted/healed or 48 hours after starting antibiotic
Hygiene advice (eg hot wash of clothes & bedding
Resource(s):
Information for patient/carer(s):