Print Print
CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.

Impetigo - Management
How should I treat a person with impetigo?

  • Non-bullous infection requires treatment with topical or oral antibiotics, and management of the underlying cause (if applicable).
    • For localized infection, treat with topical fusidic acid (three to four times daily, for 7 days).
      • Before the initial application of topical antibiotics, advise the person (or parent) to remove crusted areas by soaking them in soapy water, as long as this does not cause discomfort.
      • Topical mupirocin, retapamulin, and antiseptics are not recommended initially.
    • For extensive infection, areas on which it would be impractical to use topical drugs, or severe infection (including systemic symptoms), treat with an oral antibiotic.
      • Oral flucloxacillin (four times daily for 7 days) is recommended first-line.
      • Oral clarithromycin (twice daily for 7 days) or erythromycin (four times daily for 7 days) are alternatives if the person is allergic to penicillins.
    • The most likely underlying conditions that may be associated with impetigo are atopic eczema, scabies, or head lice. For more information on the management of these conditions, see the CKS topics on Eczema - atopic, Scabies, and Head lice.
  • Bullous infection usually requires treatment with an oral antibiotic (flucloxacillin or clarithromycin/erythromycin).
  • Routine follow-up is not required, but advise the person to return if there is no significant improvement 7 days after initiation of treatment (or sooner if the condition is worsening).

© NHS Institute for Innovation and Improvement