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Antibiotics should not be prescribed to patients with non-bullous impetigo, according to new draft guidance.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

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