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Impetigo - Management
Basis for recommendation

Information on prognosis

  • Complications with impetigo, such as streptococcal-mediated glomerulonephritis, are very rare. However, visibly unpleasant lesions, especially on the face, may cause considerable distress for children and parents, so they should be reassured about the temporary nature of the infection [Watkins, 2005].

Advice on hygiene

  • CKS found no controlled trials that investigated the effectiveness of hygiene practices in stopping the spread of infection or improving healing rates. However, the non-bullous form of impetigo is highly contagious, and these are generally accepted by experts as being appropriate measures [HPA, 1999; Nursing Times, 2004; Watkins, 2005; DTB, 2007].

Absenteeism from school or nursery

  • This recommendation is based on advice from the Health Protection Agency [HPA, 2010].
    • After consultation with expert reviewers, CKS infers that the term 'crusting' in this context refers to the scabs that form during the healing process (eschar) rather than the initial gold-crusted plaques typically seen at presentation.
    • Scab formation, indicating healing, usually occurs within 2 days of starting antibiotic treatment.
  • It is reasonable to extrapolate this advice to adults.

Treatment failure

  • Most controlled trials have shown positive results from topical and oral antibiotics after 1 week [George and Rubin, 2003; Koning et al, 2003]. If the condition is not improving after this time, or is deteriorating, it is reasonable to extend treatment, while waiting for bacterial sensitivity data.

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