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GPs should not prescribe antibiotics for impetigo, says NICE

Antibiotics should not be prescribed to patients with non-bullous impetigo, according to new draft guidance.

The joint guidelines, from NICE and Public Health England (PHE), say that GPs should recommend topical antiseptic instead of antibiotics, with the aim of reducing antimicrobial resistance.

It found that antiseptics, such as hydrogen peroxide 1% cream, were just as effective as topical antibiotics and therefore should be prescribed instead.

However, the guidelines state that GPs can still prescribe an oral antibiotic if the non-bullous impetigo is widespread, or the patient is systematically unwell or at risk of complications.

Non-bullous impetigo is the more common form of skin infection, usually starting with a rash of small, pus-filled blisters, compared to bullous impetigo, which presents with sores and intact blisters, according to the British Skin Foundation.

It is highly infectious and although usually clears up within two to three weeks without treatment, it is usually treated with an antibiotic to prevent the spread of infection and speed up recovery, according to NICE.

A spokesperson from NICE said: ‘NICE now say that topical antiseptics should be offered to people with localised, non-bullous impetigo if they aren’t systemically unwell or at risk of developing any complications.

‘If antiseptic treatment is not suitable, or a person has widespread non-bullous impetigo, a topical antibiotic should be given instead (fusidic acid 2%). An oral antibiotic (flucloxacillin) is also an option for people with widespread non-bullous impetigo and should be given first line if the person has bullous impetigo or if they are systemically unwell or at risk of developing any complications.’

The guidance also included that GPs should not combine a topical and oral antibiotic to treat impetigo, as using both is ‘no more effective’ than using one.

It follows a pledge by the Government to cut antibiotics prescribing by a further 15%.

Readers' comments (22)

  • David Banner

    I’m sure that those impetigo patients subsequently admitted with “sepsis” will be perfectly satisfied that their GP failed to prescribe an antibiotic.

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  • yes - total rubbish

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  • Anything the government orders doctors to do, people will do the exact opposite. If the government ran out of money that’s not doctors fault. Sorry

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  • It's 3 weeks to see a GP keep it that way if its not settled by then -- bingo

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  • NICE the foulest legacy of Nu-Labour

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  • @Holy Smoke Batman
    Absolutely agree. The principle is fine but unless it is funded properly, is not forced to rush things through, not subject to the external biases of big pharma, patient action groups and charities, and unless it represents broad medical views (that should involve GPs particularly- but not the Steve Field gong chasing types of course) then it will not work.
    In the meantime it is what it is. The National Institute of Clinical Excrement.

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  • This is draft guidance out for consultation. This means that those who have registered an interest can comment during the consultation. It is common for recommendations to change as a result of feedback.

    As for the GP representation; you can see the make-up of the guideline development group on the NICE website. There are 2 GPs, one is a Prof of Primary Care but the other appear not to hold any ivory tower links.

    COI I have served on NICE guideline development groups but have no link to the current topic.

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  • Facial impetigo is likely to represent URT carriage of pathogenic Staph/Strep.
    Topical treatment of any kind does nothing to address this.
    The patient remains a risk to themselves and to any contacts.
    Cases of neumonia, sepsis and scarlet fever have increased. Who is researching the impact/harms of not treating?
    Too many agenda guidelines based on too little medical evidence.

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  • and then what about school absence? The HPA advice is exclusion from school until 48 hours after antibiotics commenced, or until lesions have crusted and healed. So parents to keep kids off school for 2-3 weeks under the above guidance - I'm sure that's going to go down well on the school attendance record!

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  • Took Early Retirement

    Good point about school! Good reason for ignoring this trash.

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