Treatment options

For non-bulbous impetigo, where the person is not systemically unwell or at high risk of complications, treatment is split depending on whether the infection is localised or wide-spread.

Localised: the first-line treatment is hydrogen peroxide 1% cream, applied two or three times a day, for five days.

If this is unsuitable, a five-day course of a topical antibiotic may be required, such as fusidic acid 2%, applied three times daily for five days; or mupirocin 2%, applied three times daily for five days (if fusidic acid resistance is suspected/confirmed).

The course length for all three treatments can be increased to seven days, if required, based on clinical judgement, depending on the severity and number of lesions.⁴

Wide-spread: first-line treatment options include topical fusidic acid 2%, applied three times daily for five days; topical mupirocin 2%, applied three times daily for five days if fusidic acid resistance is suspected/confirmed); or an oral antibiotic taken for five to seven days, depending on clinical judgement. The antibiotic is likely to be flucloxacillin – if this is unsuitable, e.g. the person has a penicillin allergy, then clarithromycin or erythromycin may be an option.

Note – the antibiotic as above is also the recommended first-line treatment for bullous impetigo, or those who are systemically unwell or at high risk of complications.