NICE recommends antiseptics over antibiotics for impetigo

Localised, non-bullous impetigo should be treated with a topical antiseptic rather than an antibiotic, according to new draft guidance published by the National Institute for Health and Care Excellence (NICE) and Public Health England (PHE).

The decision comes as a result of a review by NICE and PHE that showed hydrogen peroxide 1% cream, a topical antiseptic, was just as effective as topical antibiotics in reducing the spread of infection and aiding recovery in localised, non-bullous impetigo. The aim of the update is to reduce the impact of antimicrobial resistance.

The draft guidance highlights that a topical antibiotic (fusidic acid 2%) should still be used if antiseptic treatment is contraindicated, or if the non-bullous impetigo is widespread. An oral antibiotic (flucloxacillin) should be the first line treatment in patients that present with bullous impetigo, are at risk of developing complications or are systemically unwell. 

If required, an oral antibiotic can also be an option in patients with widespread non-bullous impetigo. However, the guidance points out that a topical and oral antibiotic should not be prescribed at the same time to treat cases of impetigo, as using the two antibiotics simultaneously is no more effective in treating the infection than using one.

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