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 and eczema.

Doses are oral and for adults unless otherwise stated. Visit the Health Products Regulatory Board website or the printed Irish Medicines Formulary for drug SPCs, dosage, contraindications, interactions, or IMF/BNF/BNFC/MIMS. See guidance on dosing in children for quick reference dosage/weight guide.

Letters indicate strength of evidence range from A+ (systematic review) to D (informal opinion). Statins can interact with some antibiotics and increase the risk of rhabdomyolysis. Amiodarone and drugs which prolong the QT interval can interact with many antibiotics. Many antibiotics increase the risk of bleeding with anticoagulants. Please refer to our Drug Interactions Table for further information.

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.

The HSE Health A-Z website provides patient information on many hundreds of conditions and treatments.

Click here to view information on Impetigo

Reviewed June 2016