Treatment of localised non-bullous impetigo in patients not systemically unwell and not at high risk of complications
This protocol covers a straightforward, low-risk presentation: non-bullous impetigo that is localised, with no systemic illness and no features placing the patient at high risk of complications.
Clinical scenario
Localised non-bullous impetigo — the patient is not systemically unwell and is not at high risk of complications. In this setting, a topical outpatient approach is appropriate and systemic treatment is not required.
Treatment approach
Current guidance supports a short course of a topical antibiotic as first-line treatment in this scenario, with an alternative agent available when resistance is a clinical consideration. The full protocol details the specific agents, the circumstances favouring each, and the complete treatment plan.
Goal: cure or improvement of non-bullous impetigo by the end of the treatment course.
References
- Consider hydrogen peroxide 1% cream for people with localised non-bullous impetigo who are not systemically unwell or at high risk of complications (see recommendations on choice of antimicrobial).
- If hydrogen peroxide 1% cream is unsuitable, offer a short course of a topical antibiotic for people with localised non-bullous impetigo who are not systemically unwell or at high risk of complications (see recommendations on choice of antimicrobial).
- Fusidic acid 2%: Apply three times a day for 5 days
- Mupirocin 2%: Apply three times a day for 5 days
- A 5-day course is usually appropriate but can be increased to 7 days based on clinical judgement, depending on the severity and number of lesions.
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