Impetigo
The regional formulary will not cover all eventualities for infections medicines choices. As with any condition; patient specific factors and sensitivities need to be considered. Please consider this regional formulary advice alongside any relevant local Board guidelines.
Treatment of non-bullous impetigo
Topical treatment may be appropriate in very localised lesions.
Fusidic acid
Fusidic acid 2% cream
Apply every 8 hours for 5 days.
For people who are not systemically unwell or at a high risk of complications.
Hydrogen peroxide
Hydrogen peroxide 1% cream
Apply two or three times daily for 5 days.
Prescribing Notes:
- Increasing concerns about the development of resistance have led to topical antibiotic therapy being discouraged.
- Topical antiseptics may be used to remove crust and to prevent spread of infection, but there is no evidence to support their use in preference to washing with soapy water.
- All wounds have potential for bacterial infection and may become colonised, but swabs should only be taken if there are clinical signs of infection.
History Notes
30/07/2026
Regional formulary chapter launched.
Treatment of extensive, severe or bullous impetigo
Flucloxacillin
Flucloxacillin 500mg capsules
500mg every 6 hours for 5 days.
For penicillin allergy.
Doxycycline
Doxycycline 100mg capsules
200mg stat, then 100mg daily for 5 days. Total duration of treatment is 5 days.
Prescribing Notes:
- Increasing concerns about the development of resistance have led to topical antibiotic therapy being discouraged. Fusidic acid, three times daily for 5 days, may be appropriate in very localised lesions.
- When MRSA is isolated by Microbiology follow suppression advice in the Infection Control Manual.
- Flucloxacillin has adequate streptococcal cover; therefore it is not necessary to prescribe penicillin in addition, for empirical treatment of non-severe cellulitis. If there has been exposure to river or sea water, discuss treatment with a microbiologist.
- All wounds have potential for bacterial infection and may become colonised, but swabs should only be taken if there are clinical signs of infection.
- Prescription of antibiotics should not delay appropriate surgical management e.g. drainage or aspiration of an abscess.
History Notes
30/07/2026
Regional formulary chapter launched.