Impetigo - Antibiotic Prescribing

Doses are oral and for adults unless otherwise stated. Visit the Health Products Regulatory Authority (HPRA) website for detailed drug information (summary of product characteristics and patient information leaflets). Dosing details, contraindications and drug interactions can also be found in the Irish Medicines Formulary (IMF) or other reference sources such as British National Formulary (BNF) / BNF for children (BNFC). See guidance on dosing in children for quick reference dosage/weight guide. Refer to drug interactions table for detailed drug interactions for all antimicrobials. Note extensive drug interactions for clarithromycin, fluoroquinolones, azole antifungals and rifampicin. Many antibiotics increase the risk of bleeding with anticoagulants.

Note additional warnings for clarithromycin and fluoroquinolones

Panton-Valentine Leukocidin (PVL) is a toxin produced by 2% of Staphylococcus aureus and is associated with persistent recurrent pustules and carbuncles or cellulitis. Send swabs for culture in these clinical scenarios. On rare occasions it causes more severe invasive infections, even in otherwise fit people. Risk factors include: nursing homes, contact sports, sharing equipment, poor hygiene andeczema.

Comments from Expert Advisory Committee

  • Systematic review indicates topical and oral treatment produces similar results.A+
  • As resistance is increasing reserve topical antibiotics for very localised lesions.C or D Reserve Mupirocin for MRSA.
  • Impetigo in children is highly contagious.
  • Treat with oral flucloxacillin as per body weight.
  • See children's weight table.


See guidance on dosing in children for quick reference dosage/weight guide.

Treatment Dose TX Duration
flucloxacillin See flucloxacillin dosing table for children 7 days
OR clarithromycin See clarithromycin dosing table for children 7 days
fusidic acid Topically TDS 5 days
mupirocin (MRSA only) Topically TDS 5 days

Patient Information

We recommend patients use the website developed by HSE/ICGP/IPU partnership for tips on how to get better from common infections without using antibiotics, what you can do for yourself or a loved one and when to seek help.

Reviewed June 2016