NICE and Public Health England (PHE) have issued draft guidance on antimicrobial prescribing for impetigo, which recommends topical antiseptic such as hydrogen peroxide 1% cream (applied two to three times a day for five to seven days) instead of topical antibiotics for the first-line treatment of non‑bullous impetigo.
First-choice topical antibiotic in adults and children is fusidic acid 2% applied three times daily (td) for five to seven days. If fusidic acid resistance is suspected or confirmed, mupirocin 2% td can be used as an alternative.
Recommended first-choice oral antibiotic is flucloxacillin 500 mg four times a day (qd) for five to seven days in adults. In patients aged one month to one year, the recommended dose is 62.5 mg to 125 mg qd. In the two to nine years age group, 125 mg to 250 mg qd is recommended in the new draft guidelines. The recommended dose in 10-17-year-olds is 250 mg to 500 mg qd.
Second-choice oral antibiotics in adults are clarithromycin 250 mg to 500 mg twice daily (bd) or erythromycin (in pregnancy) 250 mg to 500 mg qd.
In patients younger than 18 years, recommended clarithromycin doses are:
- 8-11 kg: 62.5 mg bd
- 12-19 kg: 125 mg bd
- 20-29 kg: 187.5 mg bd
- 30-40 kg: 250 mg bd
- 12 to 17 years: 250 mg 500 mg bd
The recommended dose of erythromycin in patients aged eight to 17 years is 250 mg to 500 mg qd.
The draft guidelines are now open for public consultation. The consultation process will run until 5 pm 11 September 2019. The finalised guidelines are expected to be published in February 2020.